scholarly journals The Hospital Readmissions Reduction Program and Observation Hospitalizations

2021 ◽  
Author(s):  
Ann M Sheehy ◽  
Farah Kaiksow ◽  
W Ryan Powell ◽  
Andrea Gilmore Bykovskyi ◽  
Christie M Bartels ◽  
...  
Keyword(s):  
Hospital Readmissions ◽  
Fee For Service ◽  
Inpatient Hospital ◽  
Reduction Program ◽  
Inpatient Hospitalizations

The Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP) penalizes hospitals having excess inpatient rehospitalizations within 30 days of index inpatient stays for targeted conditions. Observation hospitalizations are increasing in frequency and may clinically resemble inpatient hospitalizations, yet HRRP excludes observation in index and 30-day rehospitalization counts. Using 100% 2014 Medicare fee-for-service claims and CMS’s 30-day rehospitalization methodology, we modeled how observation hospitalizations impact HRRP metrics when counted as index (denominator) and 30-day (numerator) rehospitalizations. Of 3,806,772 index hospitalizations for HRRP conditions, 418,923 (11%) were observation; 18% (155,553/876,033) of rehospitalizations were invisible to HRRP due to observation hospitalization as index (34%; 63,740/188,430), 30-day outcome (53%; 100,343/188,430), or both (13%; 24,347/188,430). By ignoring observation hospitalizations as index and 30-day events, nearly one of five HRRP rehospitalizations is missed. Policymakers might consider this an opportunity to address broad challenges of the two-tiered observation and inpatient hospital billing distinction.

Observational study assessing changes in timing of readmissions around postdischarge day 30 associated with the introduction of the Hospital Readmissions Reduction Program

2020 ◽  
pp. bmjqs-2019-010780
Author(s):  
Ashwin S Nathan ◽  
Joseph R Martinez ◽  
Jay Giri ◽  
Amol S Navathe
Keyword(s):  
Negative Binomial ◽  
Artery Bypass ◽  
Hospital Readmissions ◽  
Bypass Graft ◽  
Chronic Obstructive ◽  
Fee For Service ◽  
Obstructive Pulmonary Disease ◽  
Time Period ◽  
Significant Difference ◽  
Reduction Program

BackgroundThe Hospital Readmissions Reduction Program (HRRP) initially penalised hospitals for excess readmission within 30 days of discharge for acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA) and was expanded in subsequent years to include readmissions for chronic obstructive pulmonary disease, elective total hip arthroplasty, total knee arthroplasty and coronary artery bypass graft surgery. We assessed whether HRRP was associated with delays in readmissions from immediately before the 30-day penalty threshold to just after it.MethodsWe included Medicare fee-for-service beneficiaries discharged between 1 January 2007 and 31 October 2015. Readmissions were assessed until December 31, 2015. The study period was divided into three phases: January 2007 to March 2009 (pre-HRRP), April 2009 to September 2012 (implementation) and October 2012 to December 2015 (penalty). We estimated additional readmissions between postdischarge days 31–35 compared with days 26–30 using a negative binomial difference-in-differences model, comparing target HRRP versus non-HRRP conditions at the same hospital in the same month in the pre-HRRP and penalty phases.ResultsHRRP was not associated with a significant difference in AMI readmissions between postdischarge days 31–35 versus postdischarge days 26–30 for each hospital in the penalty phase, as compared with non-HRRP conditions and the pre-HRRP phase (p=0.19). There were statistically significant increases in readmissions CHF (0.040%, 95% CI 0.024% to 0.056%, p<0.01), PNA (0.022%, 95% CI 0.002% to 0.042%, p=0.03) and stroke (0.035%, 95% CI 0.010% to 0.060%, p<0.01); however, these readmissions represent <0.01% of readmissions during this time period.ConclusionWe did not identify consistently significant associations between HRRP and delayed readmissions, and importantly, any findings suggesting delayed readmissions were extremely small and unlikely to be clinically relevant.

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.

Abstract 1: Readmission Rates Across All Insurance Types After Passage of the Hospital Readmissions Reduction Program: A Nationwide Analysis

2019 ◽  
Vol 12 (Suppl_1) ◽  
Author(s):  
Enrico G Ferro ◽  
Eric A Secemsky ◽  
Rishi K Wadhera ◽  
Eunhee Choi ◽  
Jordan B Strom ◽  
...  
Keyword(s):  
Hospital Readmissions ◽  
Readmission Rates ◽  
Reduction Program
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