Key result
The Hospital Readmission Reduction Program was associated with a 1.28 percentage point reduction in 30-day readmissions for pneumonia under a broad definition (95% CI: -1.35 to -1.21 pp).
Why the study?
It was unknown whether changes in diagnosis assignment explained reductions in 30-day readmission for patients with pneumonia following the Hospital Readmission Reduction Program.
Do changes in the coding of inpatient pneumonia admissions explain readmission reduction following the Hospital Readmission Reduction Program (HRRP)?
Cohort (n=3,618,215)
Yes
Do changes in the coding of inpatient pneumonia admissions explain readmission reduction following the Hospital Readmission Reduction Program (HRRP)?
Effect estimate: Difference -1.28 pp (95% CI -1.35 to -1.21)
Changes in the coding of inpatient pneumonia admissions do not explain the reduction in 30-day readmissions following the implementation of the Hospital Readmission Reduction Program.
OBJECTIVE: To evaluate whether changes in diagnosis assignment explain reductions in 30-day readmission for patients with pneumonia following the Hospital Readmission Reduction Program (HRRP). DATA SOURCES: 100 percent MedPAR, 2008-2015. STUDY DESIGN: Retrospective cohort study of Medicare discharges in HRRP-eligible hospitals. Outcomes were 30-day readmission rates for pneumonia under a "narrow" definition (used for the HRRP until October 2015; n = 2 288 644) and a "broad" definition that included certain diagnoses of sepsis and aspiration pneumonia (used since October 2015; n = 3 618 215). We estimated changes in 30-day readmissions in the pre-HRRP period (January 2008-March 2010), the HRRP implementation period (April 2010-September 2012), and the HRRP penalty period (October 2012-June 2015). PRINCIPAL FINDINGS: Under the narrow definition, adjusted annual readmission rates changed by +0.07 percentage points (pp) during the pre-HRRP period (95% CI: -0.03 pp, +0.18 pp), -1.07 pp during HRRP implementation (95% CI: -1.15 pp, -0.99 pp), and -0.09 pp during the penalty period (95% CI: -0.18 pp, -0.00 pp). Under the broad definition, 30-day readmissions changed by +0.21 pp during the pre-HRRP period (95% CI: +0.12 pp, +0.30 pp), -1.28 pp during HRRP implementation (95% CI: -1.35 pp, -1.21 pp), and -0.09 pp during the penalty period (95% CI: -0.16 pp, -0.02 pp). CONCLUSIONS: Changes in the coding of inpatient pneumonia admissions do not explain readmission reduction following the HRRP.
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Buxbaum et al. (2019) conducted a cohort in Pneumonia (n=3,618,215). Hospital Readmission Reduction Program (HRRP) vs. Pre-HRRP period was evaluated on 30-day readmission rates for pneumonia (Difference -1.28 pp, 95% CI -1.35 to -1.21). The Hospital Readmission Reduction Program was associated with a 1.28 percentage point reduction in 30-day readmissions for pneumonia under a broad definition (95% CI: -1.35 to -1.21 pp).
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