Passage of the HRRP accelerated the reduction of 30-day readmission rates, averting 95.1 (95% CI, 92.6-97.5) readmissions per 10,000 discharges annually among the lowest-performing hospitals.
Observational (n=15,170,008)
Yes
Does the passage of the Hospital Readmissions Reduction Program reduce 30-day readmission rates in Medicare patients hospitalized for AMI, CHF, or pneumonia?
The passage of the HRRP was associated with a significant acceleration in the reduction of 30-day readmission rates for AMI, CHF, and pneumonia, particularly among historically low-performing hospitals.
BACKGROUND: Whether hospitals with the highest risk-standardized readmission rates (RSRRs) subsequently experienced the greatest improvement after passage of the Medicare Hospital Readmissions Reduction Program (HRRP) is unknown. OBJECTIVE: To evaluate whether passage of the HRRP was followed by acceleration in improvement in 30-day RSRRs after hospitalizations for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia and whether the lowest-performing hospitals had faster acceleration in improvement after passage of the law than hospitals that were already performing well. DESIGN: Pre-post analysis stratified by hospital performance groups. SETTING: U.S. acute care hospitals. PATIENTS: 15 170 008 Medicare patients discharged alive from 2000 to 2013. INTERVENTION: Passage of the HRRP. MEASUREMENTS: 30-day readmission rates after hospitalization for AMI, CHF, or pneumonia for hospitals in the highest-performance (0% penalty), average-performance (>0% and <0.50% penalty), low-performance (≥0.50% and <0.99% penalty), and lowest-performance (≥0.99% penalty) groups. RESULTS: Of 2868 hospitals serving 1 109 530 Medicare discharges annually, 30.1% were highest performers, 44.0% were average performers, 16.8% were low performers, and 9.0% were lowest performers. After controlling for prelaw trends, an additional 67.6 (95% CI, 66.6 to 68.4), 74.8 (CI, 74.0 to 75.4), 85.4 (CI, 84.0 to 86.8), and 95.1 (CI, 92.6 to 97.5) readmissions per 10 000 discharges were found to have been averted per year in the highest-, average-, low-, and lowest-performance groups, respectively, after passage of the law. LIMITATION: Inability to distinguish between improvement caused by the magnitude of the penalty or by different levels of health improvement in different patient populations. CONCLUSION: After passage of the HRRP, 30-day RSRRs for myocardial infarction, heart failure, and pneumonia decreased more rapidly than before the law's passage. Improvement was most marked for hospitals with the lowest prelaw performance. PRIMARY FUNDING SOURCE: National Institutes of Health.
Wasfy et al. (Mon,) conducted a observational in Acute myocardial infarction, congestive heart failure, or pneumonia (n=15,170,008). Hospital Readmissions Reduction Program (HRRP) vs. Pre-law trends was evaluated on 30-day readmission rates. Passage of the HRRP accelerated the reduction of 30-day readmission rates, averting 95.1 (95% CI, 92.6-97.5) readmissions per 10,000 discharges annually among the lowest-performing hospitals.