Why the study?
It was unknown whether the Medicare Shared Savings Program (MSSP) was associated with changes in readmissions and mortality for patients hospitalized with ischemic stroke, or whether it differentially affected safety net hospitals.
Does hospital participation in the Medicare Shared Savings Program reduce 30-day readmission and mortality rates in Medicare patients hospitalized with ischemic stroke?
Does hospital participation in the Medicare Shared Savings Program reduce 30-day readmission and mortality rates in Medicare patients hospitalized with ischemic stroke?
Hospital participation in the Medicare Shared Savings Program was associated with a slight reduction in 30-day readmissions for ischemic stroke patients, without increasing mortality.
MSSP participation was associated with modest stroke readmission reductions without mortality impact; leaves open accountable care effects on cerebrovascular outcomes.
OBJECTIVE: Hospitals participating in the Medicare Shared Savings Program (MSSP) share with the Centers for Medicare and Medicaid Services (CMS) the savings generated by reduced cost of care. Our aim was to determine whether MSSP is associated with changes in readmissions and mortality for Medicare patients hospitalized with ischemic stroke, and whether MSSP has a different impact on safety net hospitals (SNHs) compared to non-SNHs. METHODS: This study was based on the CMS Hospital Compare data for risk-standardized 30-day readmission and mortality rates for Medicare patients hospitalized with ischemic strokes between 2010 and 2017. With a propensity score-matched sample, hospital-level difference-in-difference analysis was used to determine whether MSSP was associated with changes in hospital readmission and mortality as well as to examine the impact of MSSP on SNHs compared to non-SNHs. RESULTS: MSSP-participating hospitals had slightly greater reductions in readmission rates compared to matched nonparticipating hospitals (difference, 0.25 percentage points; 95% confidence interval [CI], -0.42 to -0.08). Mortality rates decreased among all hospitals, but mortality reduction was not significantly different between MSSP-participating hospitals and matched hospitals (difference, 0.06 percentage points; 95% CI, -0.28 to 0.17). Prior to MSSP, readmission rates in SNHs were higher compared to non-SNHs, but MSSP did not have significantly different impact on hospital readmission and mortality rates for SNHs and non-SNHs. CONCLUSION: MSSP led to slightly fewer readmissions without increases in mortality for Medicare patients hospitalized with ischemic stroke. Similar reductions in readmission rates were observed in SNHs and non-SNHs participating in MSSP, indicating persistent gaps between SNHs and non-SNHs.
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Kim et al. (2020) studied this question.
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