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December 27, 2016JAMAOpen Access

Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions

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Why the study?

Does hospital penalty status under the Hospital Readmission Reduction Program reduce 30-day all-cause unplanned readmission rates for target conditions in Medicare beneficiaries?

Population

20,351,161 Medicare fee-for-service beneficiaries older than 64 years discharged between January 1, 2008…

Comparison

Hospital penalty status under the Hospital… vs Hospitals not subject to financial penalties…

Design

Cohort

Follow-up

30-day

Key result

Hospital penalty status under the HRRP was associated with significantly faster declines in readmission rates for AMI (-1.24 percentage points/year; 95% CI -1.84 to -0.65) vs nonpenalized hospitals.

Authors

NDNihar R. DesaiJRJoseph S. RossJKJi Young Kwon

Discussion

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Member takes

Overview

Supports greater AMI readmission reductions at penalized hospitals; extends HRRP evaluations but leaves causality open.

Study Design

Type

Cohort (n=20,351,161)

Multicenter

Yes

Structured PICO

Does hospital penalty status under the Hospital Readmission Reduction Program reduce 30-day all-cause unplanned readmission rates for target conditions in Medicare beneficiaries?

P
Population
20,351,161 Medicare fee-for-service beneficiaries older than 64 years (accounting for 48,137,102 hospitalizations) discharged between January 1, 2008, and June 30, 2015, from 2214 penalty hospitals and 1283 nonpenalty hospitals.
I
Intervention
Hospital penalty status under the Hospital Readmission Reduction Program (HRRP) for target conditions (acute myocardial infarction, heart failure, and pneumonia).
C
Comparator
Hospitals not subject to financial penalties under the HRRP, and nontarget conditions.
O
Outcome
Thirty-day risk adjusted, all-cause unplanned readmission rates for target and nontarget conditions.hard clinical

Main Result

Effect estimate: AMI additional decrease -1.24 percentage points/year (95% CI -1.84 to -0.65)

p-value: p=<.001

Financial penalties under the HRRP were associated with significantly greater reductions in 30-day readmission rates for target conditions at penalized hospitals compared to nonpenalized hospitals.

Cite This Study

Desai et al. (2016) conducted a cohort in Acute myocardial infarction, heart failure, and pneumonia (n=20,351,161). Hospital penalty status under the HRRP vs. Nonpenalty hospitals was evaluated on Thirty-day risk adjusted, all-cause unplanned readmission rates for target and nontarget conditions (AMI additional decrease -1.24 percentage points/year, 95% CI -1.84 to -0.65, p=<.001). Hospital penalty status under the HRRP was associated with significantly faster declines in readmission rates for AMI (-1.24 percentage points/year; 95% CI -1.84 to -0.65) vs nonpenalized hospitals.

synapsesocial.com/papers/6a10f1006eff2c4ed81622bdhttps://doi.org/10.1001/jama.2016.18533
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Reducing excess readmissions: promising effect of hospital readmissions reduction program in US hospitals2015 · 58 citations
  2. 2Readmission Rates After Passage of the Hospital Readmissions Reduction Program2016 · 165 citations
  3. 3Association of the Hospital Readmissions Reduction Program With Mortality During and After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia2018 · 122 citations
  4. 4Changes to Racial Disparities in Readmission Rates After Medicare’s Hospital Readmissions Reduction Program Within Safety-Net and Non–Safety-Net Hospitals2018 · 72 citations
  5. 5Patient Readmission Rates For All Insurance Types After Implementation Of The Hospital Readmissions Reduction Program2019 · 61 citations