Impact of the Hospital Readmission Reduction Program on Surgical Readmissions Among Medicare Beneficiaries

Abstract

Objective To understand the impact of the Hospital Readmission Reduction Program on both future targeted and non-targeted surgical procedures. Summary Background Data The Hospital Readmission Reduction Program, established under the Affordable Care Act in March of 2010, placed financial penalties on hospitals with higher-than-expected rates of readmission beginning in 2012 for targeted medical conditions. Multiple studies have suggested a “spill-over” effect into other conditions, but the extent of that effect for specific surgical procedures is unknown. Methods A retrospective review 5,122,240 Medicare beneficiaries who underwent future targeted procedures (total hip replacement, total knee replacements) or non-targeted procedures (colectomy, lung resection, abdominal aortic aneurysm repair, coronary artery bypass graft, aortic valve replacement, mitral valve repair) using an interrupted time-series model to assess the rates of readmission before the Hospital Readmission Reduction Program was announced (2008 to 2010), while the program was being implemented (2010 to 2012) and after penalties were initiated (2012 to 2014). We also explored if the change in readmission rates were correlated with changes in index length of stay, use of observation status or discharge to a skilled nursing facility. Results From 2008 to 2014 rates of readmission declined for both target conditions (6.8% to 4.8%; slope change −0.07 to −0.10, p<0.001) and non-target conditions (17.1% to 13.4%; slope change −0.04 to −0.11, p<0.001). The rate of reduction was most prominent after announcement of the program between 2010 and 2012 for both targeted and non-targeted conditions. During the same time period, mean hospital length of stay decreased; non-targeted conditions (10.4 days to 8.4 days) and targeted conditions (3.6 days to 2.8 days). There was no correlation between hospital reduction in readmissions and use of observation-only admissions (Pearson Correlation Coefficient=0.01) or discharge to a skilled nursing facility (Pearson Correlation Coefficient=0.05). Conclusions Trends in readmissions after inpatient surgery are consistent with hospitals responding to financial incentives announced in the Hospital Readmission Reduction Program. There appears to be both an anticipatory effect (future targeted procedures reducing readmission before payments implemented) as well as a spillover effect (non-targeted procedures also reducing readmissions).

Analysis of readmissions after transoral robotic surgery for oropharyngeal squamous cell carcinoma

“…[7][8][9][10][11] Unplanned readmissions have been shown to be associated with poor clinical outcomes and increased health care costs (estimated at $17.4 billion per year for all unplanned readmissions within the Medicare system in 2004). [12][13][14] The Patient Protection and Affordable Care Act and the associated Hospital Readmissions Reduction Program were implemented in 2010 to assess performance on the basis of readmission after certain index conditions and charge penalties to hospitals with higher-than-expected readmission rates. 15,16 Surgical oncology patients, particularly those undergoing therapies with a high risk of postoperative complications, present a particularly vulnerable population for readmission.…”

Trends in Postacute Care Use and Outcomes After Hip and Knee Replacements in Dual-Eligible Medicare and Medicaid Beneficiaries, 2013-2016

“…or knee replacement [30][31][32]. Model 2 of the Medicare Bundled Payments for Care Improvement initiative, which started in 2013 and encouraged hospitals to voluntarily participate in bundled payments for 1 or more of 48 episodes of care, was also shown to be associated with reduced rates of institutional PAC use and reduced duration of PAC after hip or knee replacement 2.…”

Trends in Pediatric Hospitalizations and Readmissions: 2010–2016

“…After the 2012 implementation of the Hospital Readmissions Reduction Program by the Centers for Medicare and Medicaid Services (CMS), 15,16 many hospitals developed internal strategies to reduce their readmission rates, [17][18][19][20] and several national campaigns were launched to help hospitals decrease readmission rates globally. 21 Although these efforts were largely directed at Medicare beneficiaries and for specific target conditions, studies have revealed that such hospital-wide efforts successfully decreased readmission rates in nonpenalized conditions, [22][23][24] and multiple pediatric-specific initiatives have been launched simultaneously. [25][26][27] Nevertheless, almost nothing is known about national trends in pediatric readmission rates during this time.…”