Abstract 027: Comparing Changes in Hospital Readmission Rates by Frequency and Total Financial Penalties Over the First Five Years

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Michael P Thompson ◽  
Cameron M Kaplan ◽  
Gloria J Bazzoli ◽  
Teresa M Waters
Keyword(s):  
Hospital Readmission ◽  
Fiscal Year ◽  
Readmission Rates ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Hospital Readmission Rates ◽  
Average Change ◽  
Total Penalty ◽  
Changes In Risk

Objective: To compare changes in risk-standardized readmission rates (RSRRs) for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PN) between hospitals receiving more frequent or higher total penalties under the Hospital Readmission Reduction Program (HRRP) over the first five years (fiscal year [FY] 2013-2017). Methods: Using publically available HRRP penalty data, we categorized hospitals as receiving penalties in all five years vs. fewer than five years. We also summed the penalty amounts over the first five years by hospital and hospitals based on their quartile of summed penalty amount vs. receiving no penalties. Using generalized linear regression, we estimated the average change in RSRRs for AMI, CHF, and PN by penalty frequency (all years vs. not all years) and amount (quartile of total penalty vs. no penalty) between FY 2013 and FY 2017, adjusting for hospital characteristics in the American Hospital Association Annual Survey and Medicare Impact File (both 2009-2011). Results: There were 3,346 hospitals eligible for HRRP penalties between FY 2013 and FY 2017. From this sample, 1,938 hospitals had RSRRs for AMI in both years, 2,821 hospitals had RSRRs for CHF, and 2,876 hospitals had RSRRs for PN. The average change in RSRRs for AMI, CHF, and PN was -2.8%, -2.8%, and -1.4%, respectively. Declines in RSRRs were greater for hospitals receiving penalties in all five years compared to hospitals penalized fewer than five years in AMI (-0.9%, p<0.001), CHF (-0.9%, p<0.001), and PN (-0.4%, p<0.001). Similarly, hospitals receiving the highest total penalties in the first five years of the HRRP had the largest decline in RSRRs compared to hospitals never receiving a penalty for AMI (-1.2%, p<0.001) and CHF (-0.9%, p<0.001), but not for PN (-0.2%, p = not significant). Conclusions: Hospitals receiving more frequent and higher total penalties had greater reductions in RSRRs for AMI and CHF, and to a lesser extent for PN. Our findings suggest that HRRP penalties did not limit hospitals’ ability to reduce readmissions.

scholarly journals Reduction in Hospitals’ Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities

2019 ◽  
Vol 56 ◽  
pp. 004695801881799
Author(s):  
Shivani Gupta ◽  
Ferhat D. Zengul ◽  
Ganisher K. Davlyatov ◽  
Robert Weech-Maldonado
Keyword(s):  
Hospital Readmission ◽  
Fixed Effects ◽  
Skilled Nursing Facility ◽  
Health Resources ◽  
Estimating Equation ◽  
Readmission Rates ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
American Hospital ◽  
American Hospital Association

Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role in lowering readmissions. Although having a hospital-based skilled nursing facility (HBSNF) in a hospital could help in improving care for patients needing short-term skilled nursing or rehabilitation services, little is known about HBSNFs’ association with hospitals’ readmission rates. This study seeks to examine the association between HBSNFs and hospitals’ readmission rates. Data sources included 2007-2012 American Hospital Association Annual Survey, Area Health Resources Files, the Centers for Medicare and Medicaid Services (CMS) Medicare cost reports, and CMS Hospital Compare. The dependent variables were 30-day risk-adjusted readmission rates for acute myocardial infarction (AMI), congestive heart failure, and pneumonia. The independent variable was the presence of HBSNF in a hospital (1 = yes, 0 = no). Control variables included organizational and market factors that could affect hospitals’ readmission rates. Data were analyzed using generalized estimating equation (GEE) models with state and year fixed effects and standard errors corrected for clustering of hospitals over time. Propensity score weights were used to control for potential selection bias of hospitals having a skilled nursing facility (SNF). GEE models showed that the presence of HBSNFs was associated with lower readmission rates for AMI and pneumonia. Moreover, higher SNFs to hospitals ratio in the county were associated with lower readmission rates. These findings can inform policy makers and hospital administrators in evaluating HBSNFs as a potential strategy to lower hospitals’ readmission rates.

scholarly journals Impact of Pharmacy Student–Driven Postdischarge Telephone Calls on Heart Failure Hospital Readmission Rates: A Pilot Program

2018 ◽  
Vol 54 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Roda Plakogiannis ◽  
Ana Mola ◽  
Shreya Sinha ◽  
Abraham Stefanidis ◽  
Hannah Oh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Discharge ◽  
Hospital Readmission ◽  
Pharmacy Students ◽  
Pharmacy Student ◽  
Pilot Program ◽  
Readmission Rates ◽  
Phone Calls ◽  
Hospital Readmission Rates ◽  
Telephone Calls

Background: Heart failure (HF) hospitalization rates have remained high in the past 10 years. Numerous studies have shown significant improvement in HF readmission rates when pharmacists or pharmacy residents conduct postdischarge telephone calls. Objective: The purpose of this retrospective review of a pilot program was to evaluate the impact of pharmacy student–driven postdischarge phone calls on 30- and 90-day hospital readmission rates in patients recently discharged with HF. Methods: A retrospective manual chart review was conducted for all patients who received a telephone call from the pharmacy students. The primary endpoint compared historical readmissions, 30 and 90 days prior to hospital discharge, with 30 and 90 days post discharge readmissions. For the secondary endpoints, historical and postdischarge 30-day and 90-day readmission rates were compared for patients with a primary diagnosis of HF and for patients with a secondary diagnosis of HF. Descriptive statistics were calculated in the form of means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Results: Statistically significant decrease was observed for both the 30-day ( P = .006) and 90-day ( P = .007) readmission periods. Prior to the pharmacy students’ phone calls, the overall group of 131 patients had historical readmission rates of 24.43% within 30 days and 38.17% within 90 days after hospital discharge. After the postdischarge phone calls, the readmission rates decreased to 11.45%, for 30 days, and 22.90%, for 90 days. Conclusion: Postdischarge phone calls, specifically made by pharmacy students, demonstrated a positive impact on reducing HF-associated hospital readmissions, adding to the growing body of evidence of different methods of pharmacy interventions and highlighting the clinical impact pharmacy students may have in transition of care services.

Hospital Religious Affiliation and Outcomes for High-Risk Infants

2011 ◽  
Vol 69 (3) ◽  
pp. 316-338 ◽  
Author(s):  
Melissa M. Garrido ◽  
Kirk C. Allison ◽  
Mark J. Bergeron ◽  
Bryan Dowd
Keyword(s):  
Health Care ◽  
Religious Affiliation ◽  
Perinatal Outcomes ◽  
Extremely Low Birth Weight ◽  
American Hospital ◽  
American Hospital Association ◽  
For Profit ◽  
Annual Survey ◽  
Not For Profit ◽  
Organizational Affiliation

The effect of hospital organizational affiliation on perinatal outcomes is unknown. Using the 2004 American Hospital Association Annual Survey and Healthcare Cost and Utilization Project State Inpatient Databases, the authors examined relationships among organizational affiliation, equipment and service availability and provision, and in-hospital mortality for 5,133 infants across five states born with very low and extremely low birth weight and congenital anomalies. In adjusted bivariate probit selection models, the authors found that government hospitals had significantly higher mortality rates than not-for-profit nonreligious hospitals. Mortality differences among other types of affiliation (Catholic, not-for-profit religious, not-for-profit nonreligious, and for-profit) were not statistically significant. This is encouraging as health care reform efforts call for providers at facilities with different institutional values to coordinate care across facilities. Although there are anecdotes of facility religious affiliation being related to health care decisions, the authors did not find evidence of these relationships in their data.

Accountable care organizations: a strategy for future success?

2018 ◽  
Vol 21 (2) ◽  
pp. 113-121
Author(s):  
Jeffrey Harrison ◽  
Aaron Spaulding ◽  
Debra A. Harrison
Keyword(s):  
Community Dynamics ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Healthcare Organizations ◽  
American Hospital ◽  
American Hospital Association ◽  
Content Type ◽  
For Profit ◽  
Annual Survey ◽  
Final Rule

Purpose The purpose of this paper is to assess the community dynamics and organizational characteristics of US hospitals that participate in accountable care organizations (ACO). Design/methodology/approach Data were obtained from the 2015 American Hospital Association annual survey and the 2015 medicare final rule standardizing file. The study evaluated 785 hospitals which operate ACO in contrast to 1,446 hospitals without an ACO. Findings In total, 89 percent of hospitals using ACO’s are located in urban communities and 87 percent are not-for-profit. Hospitals with a higher case mix index are more likely to have an ACO. Practical implications ACOs allow healthcare organizations to expand their geographic markets, achieve greater efficiencies, and enhance the development of new clinical services. They also shift the focus of care from acute care hospitalization to the full continuum of care. Originality/value This research found ACOs with hospital and physician networks are an effective mechanism to control healthcare costs and reduce medical errors.

Abstract 169: Targeting Patients with Multiple Readmissions in the Year after Non-ST-Elevation Myocardial Infarction Could Lower Hospital Readmission Rates

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Gwen Bernacki ◽  
Karen Alexander ◽  
Matthew Roe ◽  
Shuang Li ◽  
Laine Thomas ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Readmission ◽  
Transitional Care ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
High Risk Group ◽  
Billing Data ◽  
Readmission Rates ◽  
Bundled Payment ◽  
Hospital Readmission Rates

Background: Bundled payment policies have focused on 30-day readmission rates after AMI, yet these are likely to lengthen over time. Identifying patients with multiple readmissions in the year after AMI could help focus transitional care efforts on these high risk patients. Methods: Data from the CRUSADE registry linked to Medicare billing data was used to examine longitudinal outcomes of 32,776 NSTEMI patients ≥ 65 years between 2003 and 2006 with 12-month follow-up. Defining frequent readmissions as ≥3 hospitalizations in 12 months, we compared characteristics of patients frequently readmitted vs. not. The association between frequent readmissions and patient characteristics was examined using multivariable logistic regression. Results: Readmission within 12 months after NSTEMI occurred: once (N=8,830, 26.9%); twice (N=4334, 13.2%); 3 times (N=2,319, 7.1%); ≥4 times (N=2470, 7.5%). Those with multiple (≥3) readmissions (14.6%) were older with recent prior hospitalization and greater prevalence of comorbidities. In multivariable analysis, these factors increased discrimination of patients with frequent readmissions, (c-statistic=0.714). Conclusions: Comorbidities and recent prior hospitalization can predict patients with frequent readmissions. Better understanding of the influence of these clinical factors in this high-risk group presents an opportunity to lower hospital readmission rates.

Abstract 14996: Healthcare Resource Utilization and Costs in Congestive Heart Failure 90-day Episodes Within the Bundled Payment for Care Initiative (BPCI) Model 2, 2016-2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Xian Shen ◽  
Gabriel Sullivan ◽  
Mark Adelsberg ◽  
Martins Francis ◽  
Taylor T Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Hospital Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Angiotensin Receptor ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Initial Hospital

Introduction: Congestive heart failure (HF) is the fourth most commonly selected clinical episode among Model 2 participants of the Medicare Bundled Payments for Care Improvement (BPCI) Initiative. This study describes utilization of pharmacologic therapies, hospital readmission rates, and HF episode costs within the BPCI framework. Methods: The 100% sample of Medicare FFS enrollment/claims were used to identify acute hospital stays with a MS-DRG 291/292/293 between 1JAN2016 and 31DEC2018. A HF episode consisted of the initial hospital stay and all Part A & B covered services up to 90-days post-discharge. Prescription fills for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNI) during the 90 days post-discharge were captured. Rates of all-cause and HF readmissions were reported per 10,000 episodes during the 30-, 60-, and 90-days post-discharge period. Total episode costs were defined as the sum of Medicare payments for the initial hospital stay plus all Part A & B covered medical services in the 90-day post-discharge. Results: The sample included 634,307 HF episodes. Patients received ARNIs in 3%, ACEIs/ARBs in 45%, and neither in 52% of the episodes, respectively. All-cause hospital readmission rates were 2,503, 4,465, and 6,368 per 10,000 episodes during the 30-, 60-, and 90-day periods. The 30-, 60-, and 90-day HF readmission rates were 958, 1,696, and 2,394 per 10,000 episodes. Total mean 90-day episode cost was $20,122, of which $8,002 was attributable to hospital readmissions. Conclusions: Hospital readmissions are frequent for HF patients and contribute a notable proportion of overall HF BPCI episode costs. BPCI participants may consider improving utilization of guideline directed medical therapies for HF, including ACEIs/ARBs and ARNI, as a strategy for reducing hospital readmissions and associated costs.

scholarly journals Suitability of elderly adult hospital readmission rates for profiling readmissions in younger adult and pediatric populations

2020 ◽  
Vol 55 (2) ◽  
pp. 277-287
Author(s):  
Emily M. Bucholz ◽  
Sara L. Toomey ◽  
Neel M. Butala ◽  
Alyna T. Chien ◽  
Robert W. Yeh ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Elderly Adult ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Pediatric Populations ◽  
Adult Hospital
Sign in / Sign up

Export Citation Format

Share Document