Unintended Consequences of Hospital Regulation: The Case of the Hospital Readmissions Reduction Program

2018 ◽  
Author(s):  
Christopher Chen ◽  
Nicos Savva
Keyword(s):  
Hospital Readmissions ◽  
Unintended Consequences ◽  
Hospital Regulation ◽  
Reduction Program

scholarly journals The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations

2014 ◽  
Vol 49 (3) ◽  
pp. 818-837 ◽  
Author(s):  
Qian Gu ◽  
Lane Koenig ◽  
Jennifer Faerberg ◽  
Caroline Rossi Steinberg ◽  
Christopher Vaz ◽  
...  
Keyword(s):  
Vulnerable Populations ◽  
Hospital Readmissions ◽  
Unintended Consequences ◽  
Reduction Program

Hospital Readmissions Reduction Program: Intended and Unintended Effects

2017 ◽  
Vol 76 (5) ◽  
pp. 643-660 ◽  
Author(s):  
Min Chen ◽  
David C. Grabowski
Keyword(s):  
Heart Failure ◽  
Heart Attack ◽  
Hospital Readmissions ◽  
Unintended Consequences ◽  
Chronic Obstructive ◽  
Cost Shifting ◽  
Discharge Disposition ◽  
Reduction Program ◽  
Insured Patients ◽  
Privately Insured

This study examines whether the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excess readmissions for certain conditions, has reduced hospital readmissions and led to unintended consequences. Our analyses of Florida hospital administrative data between 2008 and 2014 find that the HRRP resulted in a reduction in the likelihood of readmissions by 1% to 2% for traditional Medicare (TM) beneficiaries with heart failure, pneumonia, or chronic obstructive pulmonary disease. Readmission rates for Medicare Advantage (MA) beneficiaries and privately insured patients with heart attack and heart failure decreased even more than TM patients with the same target condition (e.g., for heart attack, the likelihood for TM beneficiaries to be remitted is 2.2% higher than MA beneficiaries and 2.3% higher than privately insured patients). We do not find any evidence of cost-shifting, delayed readmission, or selection on discharge disposition or patient income. However, the HRRP reduced the likelihood of Hispanic patients with target conditions being admitted by 2% to 4%.

Vulnerable Phase of Acute Heart Failure and its Association with Hospital Readmissions Reduction Program

2021 ◽  
pp. 100904
Author(s):  
Azka Latif ◽  
Noman Lateef ◽  
Scott Lundgren ◽  
Vikas Kapoor ◽  
Muhammad Junaid Ahsan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Hospital Readmissions ◽  
Reduction Program

Abstract 014: Evaluation of Readmission after Acute Myocardial Infarction for Patients Included in Medicare’s Hospital Readmissions Reduction Program

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Lila M Martin ◽  
Ryan W Thompson ◽  
Timothy G Ferris ◽  
Jagmeet P Singh ◽  
Elizabeth Laikhter ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Readmissions ◽  
Index Hospitalization ◽  
Readmission Rates ◽  
Troponin Elevation ◽  
Reduction Program ◽  
Improve Accuracy ◽  
Episodes Of Care ◽  
Index Hospital

Introduction: Medicare’s Hospital Readmissions Reduction Program assesses financial penalties for hospitals based on risk-standardized readmission rates after specific episodes of care, including acute myocardial infarction (AMI). Whether the algorithm accurately identifies patients with AMI who have preventable readmission is unknown. Methods: Using administrative data from Medicare, we conducted physician-adjudicated chart reviews of all patients considered 30 day readmissions after AMI attributed to one hospital from July 2012-June 2015. We extracted information about revascularization during index hospitalization. For patients readmitted to the index hospital or an affiliate, we also extracted reason for readmission. Results: Of 199 admissions, 66 (33.2%) received PCI and 19 (9.6%) underwent CABG on index hospitalization. The remainder of patients did not receive any intervention, i.e. 39 patients (19.6%) were declined due to procedural risk, 15 (7.5%) because of goals of care and 14 (7.0%) refused revascularization. Forty-six patients (23.1%) had troponin elevation in the absence of an MI and did not have an indication for revascularization. The most common diagnoses of the 161 (80.9%) patients readmitted to the index hospital or an affiliate were infections and cardiac and non-cardiac chest discomfort (Table 1). Conclusions: Our results demonstrate that many AMI patients who count towards the Medicare penalty do not receive revascularization during the index hospitalization because of high procedural risk or patient preference. Focusing on these patients may improve readmission metric performance. Furthermore, adding administrative codes for prohibitive procedural risk may improve accuracy of the metric as a measure of quality.

scholarly journals Does a Reduction in Readmissions Result in Net Savings for Most Hospitals? An Examination of Medicare’s Hospital Readmissions Reduction Program

2018 ◽  
Vol 77 (4) ◽  
pp. 334-344 ◽  
Author(s):  
Olga Yakusheva ◽  
Geoffrey J. Hoffman
Keyword(s):  
Program Effectiveness ◽  
Hospital Readmissions ◽  
Fiscal Year ◽  
Medicare Reimbursement ◽  
Data Set ◽  
Average Hospital ◽  
Reduction Program ◽  
Program Costs ◽  
Hospital Compare ◽  
The Impact

This study aimed (1) to estimate the impact of an incremental reduction in excess readmissions on a hospital’s Medicare reimbursement revenue, for hospitals subject to penalties under the Medicare’s Hospital Readmissions Reduction Program and (2) to evaluate the economic case for an investment in a readmission reduction program. For 2,465 hospitals with excess readmissions in the Fiscal Year 2016 Hospital Compare data set, we (1) used the Hospital Readmissions Reduction Program statute to estimate hospital-specific Medicare reimbursement gains per an avoided readmission and (2) carried out a pro forma analysis of investment in a broad-scale readmission reduction program under conservative assumptions regarding program effectiveness and using program costs from earlier studies. For an average hospital, avoiding one excess readmission would result in reimbursement gains of $10,000 to $58,000 for Medicare discharges. The economic case for investments in a readmission reduction effort was strong overall, with the possible exception of hospitals with low excess readmissions.

scholarly journals Reducing Hospital Readmissions: A PatientBond Case Study

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Brent Walker
Keyword(s):  
Patient Engagement ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Hospital Readmissions ◽  
Rehospitalization Rate ◽  
Hospital Readmission Reduction Program ◽  
Reduction Program

Readmission penalties on hospitals hit a new high in 2016, increasing by a fifth over 2015 numbers to $528 million. Yet, according to data from the Centers for Medicare & Medicaid Services (CMS), the 30-day readmission rate is on the decline. Since the Hospital Readmission Reduction Program (HRRP) began in 2010, preventable readmissions have dropped by 8% nationally.1 So why will hospitals lose out on more than half a billion dollars in CMS reimbursements next year? Changes in how the rehospitalization rate is calculated influenced the jump in penalties. But that is not the only factor influencing 30-day readmissions. Patient engagement efforts often fall short, too.

scholarly journals Medicareʼs Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals

2015 ◽  
Vol 261 (6) ◽  
pp. 1027-1031 ◽  
Author(s):  
Terry Shih ◽  
Andrew M. Ryan ◽  
Andrew A. Gonzalez ◽  
Justin B. Dimick
Keyword(s):  
Hospital Readmissions ◽  
Reduction Program

Did the Hospital Readmissions Reduction Program Reduce Readmissions? An Assessment of Prior Evidence and New Estimates

2021 ◽  
pp. 0193841X2110697
Author(s):  
Engy Ziedan ◽  
Robert Kaestner
Keyword(s):  
Risk Adjustment ◽  
Research Question ◽  
Hospital Readmissions ◽  
Internal Validity ◽  
Empirical Assessment ◽  
Reduction Program ◽  
Regression Kink Design ◽  
Empirical Approaches

In this article, we provide a comprehensive, empirical assessment of the hypothesis that the Hospital Readmissions Reduction Program (HRRP) affected hospital readmissions. In doing so, we provide evidence as to the validity of prior empirical approaches used to evaluate the HRRP and we present results from a previously unused approach to study this research question—a regression-kink design. Results of our analysis document that the empirical approaches used in most prior research assessing the efficacy of the HRRP often lack internal validity. Therefore, results from these studies may not be informative about the causal consequences of the HRRP. Results from our regression-kink analysis, which we validate, suggest that the HRRP had little effect on hospital readmissions. This finding contrasts with the results of most prior studies, which report that the HRRP significantly reduced readmissions. Our finding is consistent with conceptual considerations related to the assumptions underlying HRRP penalty: in particular, the difficulty of identifying preventable readmissions, the highly imperfect risk adjustment that affects the penalty determination, and the absence of proven tools to reduce readmissions.

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