The Impact of the Hospital Readmissions Reduction Program across Insurance Types in California

Zingmond, David S.; Liang, Li‐Jung; Parikh, Punam P.; Escarce, José J.

doi:10.1111/1475-6773.12869

Cited by 12 publications

(12 citation statements)

References 24 publications

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“…However, the precise mechanisms underlying this trend are unclear. Although this pattern could be consistent with anticipatory and spillover effects of the HRRP on all patients treated within the same HRRP-eligible hospitals 30,31 , it may also be consistent with the mounting evidence that broad declines in readmissions since the passage of the U.S. Affordable Care Act may be attributable to factors beyond the threat of HRRP penalties [32][33][34][35][36][37] .…”

Section: Discussionsupporting

confidence: 64%

“…These studies demonstrated declines in surgical readmission rates since at least 2008; however, much of these declines occurred prior to the actual implementation of the HRRP penalties for total hip and knee replacement readmissions. Furthermore, the use of patient-level control groups from the same hospital in these studies makes it difficult to rule out HRRP-associated spillover effects 30,31 and thus determine the direct effect of the HRRP penalties. Our study addressed this concern by exploiting hospital-level variation in the relative size of potential HRRP penalties.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Hospital Readmissions Reduction Program Penalties on Hip and Knee Replacement Readmissions

Thirukumaran

McGarry

Glance

et al. 2019

The Journal of Bone and Joint Surgery

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Background: Little is known about the impact of the U.S. Centers for Medicare & Medicaid Services' Hospital Readmissions Reduction Program (HRRP) expansion to include readmissions following elective primary total hip and knee replacements; the expansion was finalized in 2013 and was implemented in 2014. We examined whether hospitals at risk of relatively large penalties from this expansion experienced greater declines in joint replacement readmissions compared with hospitals at risk of smaller penalties. Methods: We used Medicare's 2009 to 2016 Hospital Compare data sets to examine the impact of the HRRP's expansion in the July 2013 to June 2016 period (post-expansion) compared with the July 2009 to June 2012 period (preexpansion). The primary outcome was the hospital-level, 30-day, risk-standardized readmission rate (hereafter called the readmission rate) following joint replacement surgical procedures. We used the percentage of a hospital's total inpatient revenue attributed to Medicare (categorized into quartiles) to represent the risk of penalties. We used hierarchical linear regression models to examine the adjusted impact of the HRRP's expansion. Results: Our study cohort included 2,326 acute care hospitals. In the pre-HRRP expansion phase, the mean readmission rate was 5.36% among hospitals with the highest proportion of Medicare revenues (quartile 4) and 5.46% among hospitals with the lowest proportion of Medicare revenues (quartile 1). With the HRRP expansion, the readmission rate declined by 18.92% (1.01 percentage points) among quartile-4 hospitals and by 17.97% (0.98 percentage point) among quartile-1 hospitals (p = 0.45). This nonsignificant difference in readmission rate declines between quartiles persisted in multivariable analysis (a decline of 18.41% [0.98 percentage point] in quartile 4 and a decline of 17.35% [0.94 percentage point] in quartile 1; p = 0.35). Conclusions: The HRRP's expansion to include joint replacements did not lead to greater reductions in postoperative readmissions among hospitals at risk of larger penalties in comparison with hospitals at risk of smaller penalties. Readmission rates were declining at similar rates among all hospitals, before and after the HRRP's expansion. Clinical Relevance: Readmissions and complications following joint replacements are measures of the quality of surgical care. These events have important clinical and economic implications for patients and providers. This study is clinically relevant because it examines whether policy interventions, such as the HRRP, have the potential to reduce these unintended consequences of surgical care. I n 2012, the U.S. Centers for Medicare & Medicaid Systems implemented the Hospital Readmissions Reduction Program (HRRP) to encourage hospitals to reduce read-missions for medical conditions. Under this initiative, hospitals with higher-than-expected readmission rates for Medicare feefor-service patients receive penalties as high as 3% of their base Disclosure: The efforts of Drs. Thirukumaran, Glance, Cai, and Li a...

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Impact of Hospital Readmissions Reduction Program Penalties on Hip and Knee Replacement Readmissions

Thirukumaran

McGarry

Glance

et al. 2019

The Journal of Bone and Joint Surgery

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“…In addition, there are worries that hospitals may use triage methods to reduce readmissions, as well as increase the number of patients that are admitted for observation when an admission is warranted (Gupta & Fonarow, ). Regardless, published studies have been divisive in terms of the effectiveness of the HRRP in reducing 30‐day readmission rates, particularly in regard to HF patients (Gupta et al, ; Gupta & Fonarow, ; Lu, Huang, & Johnson, ; Wasfy et al, ; Zingmond, Liang, Parikh, & Escarce, ; Zohrabian, Kapp, & Simoes, ). Currently, an increasing number of studies are being done to look at whether 30‐day readmission rates are suitable for diseases other than HF, acute MI and pneumonia, one of which is aneurysmal subarachnoid hemorrhages (SAHs).…”

Section: Thirty‐day Readmission As a Quality Indicatormentioning

confidence: 99%

Thirty‐day readmissions in aneurysmal subarachnoid hemorrhage: A good metric for hospital quality?

2019

J of Neuroscience Research

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Thirty-day readmission rates has been increasingly used by clinicians, hospital administrators, and policy makers as a metric for the quality of care. However, the 30-day readmission rates may be affected by other factors intrinsic to the patient and may not be a good measure of the quality of care provided by the hospital. In this review, we examined the quality of the 30-day readmissions rate as a quality metric for the quality of care provided to patients with aneurysmal subarachnoid hemorrhage (SAH). It has been shown that in this patient population, 30-day readmission rate primarily captures values, such as the number of comorbidities, disease severity, and discharge dispositions. There is little association between SAH 30-day readmission rates and mortality.However, 30-day readmissions may be reduced by increasing early discharge surveillance, providing readmission reduction programs to patients discharged to medical facilities as well as to home, and identifying patients most at risk for readmission. K E Y W O R D Saneurysm, hospital quality, readmissions, subarachnoid hemorrhage

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“…Recent studies have evaluated the overall effects of the HRRP on readmissions at both the state (Carey & Lin, 2015; Chen & Grabowski, 2017; McGarry, Blankley, & Li, 2016; Mellor, Daly, & Smith, 2017; Zingmond, Liang, Parikh, & Escarce, 2018) and national levels (Gupta, 2017) using discharge or claims data. These studies generally show that the implementation of the HRRP is associated with a decrease in readmission rates among Medicare beneficiaries with the targeted conditions (i.e., AMI, CHF, PN, COPD, elective joint replacement).…”

Section: Introductionmentioning

confidence: 99%

“…However, the reductions in readmission rates appear to be the greatest and the most consistent for AMI, with estimated reductions in readmission rates ranging around 1 to 4 percentage points between pre- and postimplementation periods. Some studies find significant reductions in readmission rates due to heart failure (Carey & Lin, 2015; Chen & Grabowski, 2017; Gupta, 2017; Zingmond et al, 2018) and PN (Zingmond et al, 2018) but with smaller magnitudes in comparison with AMI. While some authors find no dose–response relationship between the risk and the amount of penalty (McGarry et al, 2016), others (Gupta, 2017; Mellor et al, 2017) find evidence of such a relationship using quasi-experimental econometric methods.…”

Section: Introductionmentioning

confidence: 99%

The Supply of Hospital Care to Minority and Low-Income Communities and the Hospital Readmission Reduction Program

2019

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To determine if the Centers for Medicare and Medicaid Services Hospital Readmission Reduction Program reduced hospital discharges for penalized conditions in minority and low-income communities, we used hospital discharge data for 2006 and 2013 from Arizona, California, Colorado, Florida, New Jersey, New York, North Carolina, and Wisconsin and readmission data from the Medicare Hospital Compare website. Negative binomial regression was used for 6,564 zip codes for each year to estimate the association between the expected penalty for an excess readmission in the hospital service area and the number of hospital discharges for penalized conditions (acute myocardial infarction, congestive heart failure, and pneumonia) for zip codes. The results showed that the expected penalty for excess readmissions had a negative association with the number of discharges for acute myocardial infarction, congestive heart failure, and pneumonia. The negative association increased with the percentage of minority residents but not with the poverty rate.

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The Impact of the Hospital Readmissions Reduction Program across Insurance Types in California

Abstract: Post-HRRP, greater than expected reductions occurred in rehospitalizations for patients with Medicare FFS and Medicare MC. HRRP incentives may be influencing system-wide changes influencing care outside of traditional Medicare.

Cited by 12 publications

References 24 publications

Impact of Hospital Readmissions Reduction Program Penalties on Hip and Knee Replacement Readmissions

Impact of Hospital Readmissions Reduction Program Penalties on Hip and Knee Replacement Readmissions

Thirty‐day readmissions in aneurysmal subarachnoid hemorrhage: A good metric for hospital quality?

The Supply of Hospital Care to Minority and Low-Income Communities and the Hospital Readmission Reduction Program

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