The Hospital Readmissions Reduction Program was associated with a statistically significant overall reduction in 30-day readmission rates for targeted conditions, with a 0.8 percentage point greater decline among Medicare patients compared to those with non-targeted conditions.
Observational (n=34,000,000)
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Does the Hospital Readmissions Reduction Program (HRRP) reduce 30-day readmissions in vulnerable populations with acute myocardial infarction, heart failure, and pneumonia?
The HRRP successfully reduced 30-day readmissions for targeted conditions like AMI and HF, including among vulnerable populations, though disparities in readmission rates remain.
Mean Difference: -0.008
valor p: p=<0.01
BACKGROUND: The Hospital Readmissions Reduction Program (HRRP) was established by the 2010 Patient Protection and Affordable Care Act (ACA) in an effort to reduce excess hospital readmissions, lower health care costs, and improve patient safety and outcomes. Although studies have examined the policy's overall impacts and differences by hospital types, research is limited on its effects for different types of vulnerable populations. The aim of this study was to analyze the impact of the HRRP on readmissions for three targeted conditions (acute myocardial infarction, heart failure, and pneumonia) among four types of vulnerable populations, including low-income patients, patients served by hospitals that serve a high percentage of low-income or Medicaid patients, and high-risk patients at the highest quartile of the Elixhauser comorbidity index score. METHODS: Data on patient and hospital information came from the Nationwide Readmission Database (NRD), which contained all discharges from community hospitals in 27 states during 2010-2014. Using difference-in-difference (DD) models, linear probability regressions were conducted for the entire sample and sub-samples of patients and hospitals in order to isolate the effect of the HRRP on vulnerable populations. Multiple combinations of treatment and control groups and triple difference (DDD) methods were used for testing the robustness of the results. All models controlled for the patient and hospital characteristics. RESULTS: There have been statistically significant reductions in readmission rates overall as well as for vulnerable populations, especially for acute myocardial infarction patients in hospitals serving the largest percentage of low-income patients and high-risk patients. There is also evidence of spillover effects for non-targeted conditions among Medicare patients compared to privately insured patients. CONCLUSIONS: The HRRP appears to have created the right incentives for reducing readmissions not only overall but also for vulnerable populations, accruing societal benefits in addition to previously found reductions in costs. As the reduction in the rate of readmissions is not consistent across patient and hospital groups, there could be benefits to adjusting the policy according to the socioeconomic status of a hospital's patients and neighborhood.
Gai et al. (Thu,) conducted a observational in Acute myocardial infarction, heart failure, and pneumonia (n=34,000,000). Hospital Readmissions Reduction Program (HRRP) vs. Pre-HRRP period and non-targeted conditions (GI) or privately insured patients was evaluated on 30-day hospital readmission for HRRP-targeted conditions (Difference-in-Difference -0.008, p=<0.01). The Hospital Readmissions Reduction Program was associated with a statistically significant overall reduction in 30-day readmission rates for targeted conditions, with a 0.8 percentage point greater decline among Medicare patients compared to those with non-targeted conditions.
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