Trends in readmission rates for safety net hospitals and non-safety net hospitals in the era of the US Hospital Readmission Reduction Program: a retrospective time series analysis using Medicare administrative claims data from 2008 to 2015

Abstract

ObjectiveTo compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP).DesignA retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015.SettingWe examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital’s proportion of patients with low socioeconomic status.ParticipantsAdmissions for Medicare fee-for-service patients, age ≥65 years, discharged alive, who had a valid five-digit zip code and did not have a principal discharge diagnosis of cancer or psychiatric illness were included, for a total of 52 516 213 index admissions.Primary and secondary outcome measuresMean hospital-level, all-condition, 30-day risk-adjusted standardised unplanned readmission rate, measured quarterly, along with quarterly rate of change, and an interrupted time series examining: April–June 2010, after HRRP was passed, and October–December 2012, after HRRP penalties were implemented.Results58.0% (SD 15.3) of safety net hospitals and 17.1% (SD 10.4) of non-safety net hospitals’ patients were in the lowest quartile of socioeconomic status. The mean safety net hospital standardised readmission rate declined from 17.0% (SD 3.7) to 13.6% (SD 3.6), whereas the mean non-safety net hospital declined from 15.4% (SD 3.0) to 12.7% (SD 2.5). The absolute difference in rates between safety net and non-safety net hospitals declined from 1.6% (95% CI 1.3 to 1.9) to 0.9% (0.7 to 1.2). The quarterly decline in standardised readmission rates was 0.03 percentage points (95% CI 0.03 to 0.02, p<0.001) greater among safety net hospitals over the entire study period, and no differential change among safety net and non-safety net hospitals was found after either HRRP was passed or penalties enacted.ConclusionsSince HRRP was passed and penalties implemented, readmission rates for safety net hospitals have decreased more rapidly than those for non-safety net hospitals.

National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016

“…While previous studies examined trends in emergency readmission rates for different types of hospitals 45 and surgical emergency readmission rates for selected patient subgroups as a measure for quality of care in the USA, 46 this is the first study that provides a comprehensive overview of trends in risk-adjusted, 30-day emergency readmissions and variation in England over a 10-year period and disaggregated for nine clinical conditions. One study that had reported on trends of English emergency readmission rates before focused on a period up to May 2010, but did not disaggregate by clinical condition.…”

Readmission Rates for Chronic Obstructive Pulmonary Disease Under the Hospital Readmissions Reduction Program: an Interrupted Time Series Analysis

“…37,38 In an analysis of CMS hospital-level data on COPD, as readmissions fell, all-cause risk-standardized mortality increased, 39 though COPD-specific mortality has not been evaluated. The potential disproportionate penalization of safety net hospitals is another concern, [40][41][42][43] particularly in COPD. 44 The effects of the HRRP expansion to include COPD on these outcomes require further study.…”

How Have 30-Day Readmission Penalties Affected Racial Disparities in Readmissions?: an Analysis from 2007 to 2014 in Five US States

“…Our findings are similar to other recent papers by Figueroa and colleagues who found similar reductions in disparities using national data. 21 In addition, previous studies have shown that safety-net hospitals have seen greater improvements in readmissions, 3,22 but the fact that disparities also decreased suggests that these constrained hospitals were still able to reduce readmissions for Black patients. Nonetheless, safetynet hospitals are among the most adversely affected by HRRP.…”