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February 17, 2021JAMA Network OpenOpen Access

Association of Inclusion of Medicare Advantage Patients in Hospitals’ Risk-Standardized Readmission Rates, Performance, and Penalty Status

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Key result

Including Medicare Advantage patients in readmission metrics changes penalty status for ~23% of US hospitals.

  • n=5,456,663

Why the study?

Exclusively reporting readmission rates for traditional Medicare beneficiaries under the Hospital Readmissions Reduction Program may not accurately reflect hospitals' readmission rates for older adults.

Does the inclusion of Medicare Advantage patients in calculating risk-standardized readmission rates change hospital performance and penalty status compared to using traditional Medicare patients alone?

Population

TM and MA patients admitted and discharged alive for AMI, CHF, or pneumonia at 4070 US hospitals

Comparison

Inclusion of MA beneficiaries vs TM-only data for calculating 30-day RSRRs and penalty status

Design

Retrospective cohort study

Follow-up

30 days

Authors

OPOrestis A. PanagiotouKVKirsten VoorhiesLKLaura M. Keohane

Discussion

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Member takes

Overview

May alter penalty status for 23% of hospitals; leaves open whether Medicare Advantage inclusion improves readmission metric validity.

Study Design

Type

Cohort (n=5,456,663)

Multicenter

Yes

Structured PICO

Does the inclusion of Medicare Advantage patients in calculating risk-standardized readmission rates change hospital performance and penalty status compared to using traditional Medicare patients alone?

P
Population
5,456,663 patients admitted and discharged alive with a diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia between 2011 and 2015 at 4,070 US acute care hospitals admitting both traditional Medicare (TM) and Medicare Advantage (MA) patients.
I
Intervention
Inclusion of Medicare Advantage (MA) patients in calculating 30-day risk-standardized readmission rates (RSRRs).
C
Comparator
Exclusively using traditional Medicare (TM) patients for calculating 30-day RSRRs.
O
Outcome
Readmission for any reason occurring within 30 days after discharge, and estimated changes in hospitals' performance and eligibility for financial penalties.

Including Medicare Advantage patients in hospital readmission metrics changes the financial penalty status for nearly a quarter of US hospitals, suggesting current traditional Medicare-only metrics may not accurately reflect overall hospital quality.

Cite This Study

Panagiotou et al. (2021) conducted a cohort in Acute myocardial infarction, congestive heart failure, or pneumonia (n=5,456,663). Inclusion of Medicare Advantage (MA) patients in readmission measures vs. Traditional Medicare (TM) patients only was evaluated on Readmission for any reason within 30 days after discharge and change in hospital penalty status. Including Medicare Advantage patients in 30-day risk-standardized readmission rate calculations changed the financial penalty status for 23% of US hospitals for at least 1 of 3 conditions.

synapsesocial.com/papers/6a194f29f2eb401dc788e66dhttps://doi.org/10.1001/jamanetworkopen.2020.37320
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Also Consider

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

  1. 1Effect of a Hospital-wide Measure on the Readmissions Reduction Program2017 · 48 citations
  2. 2An Administrative Claims Measure Suitable for Profiling Hospital Performance Based on 30-Day All-Cause Readmission Rates Among Patients With Acute Myocardial Infarction2011 · 330 citations
  3. 3Association of Coded Severity With Readmission Reduction After the Hospital Readmissions Reduction Program2017 · 155 citations
  4. 4Age Differences in Hospital Mortality for Acute Myocardial Infarction: Implications for Hospital Profiling2017 · 15 citations
  5. 5Rehospitalizations among Patients in the Medicare Fee-for-Service Program2009 · 5,228 citations