Prediction of rehospitalization and mortality risks for skilled Better Information for Better Women's Health - WebMD The primary exposure was whether a patient was directly affected by the HRRP policy (i.e., treatment group) or not directly affected (i.e., control group) based on their insurance status, age, and medical conditions. In the full sample of patients, a statistically significant decline in readmissions occurred for Medicare AMI patients (a reduction of 1.2% relative to Medicare GI patients and 0.9% relative to private insurance patients), Medicare HF patients (0.8% relative to Medicare GI and private insurance), Medicare PN patients (0.5% relative to Medicare GI and 0.8% relative to private insurance), and HRRP-targeted conditions overall (0.8% relative to Medicare GI and 0.7% relative to private insurance). Readmission rates over 20102014 for All, Medicare AMI, Medicare HF, Medicare PN and Medicare GI patients. Medicare's readmissions-reduction program--a positive alternative. Unlike other developed countries such as Canada, UK, and Germany, the United States does not have universal health care. PubMedGoogle Scholar. means youve safely connected to the .gov website. The Hospital Readmissions Reduction Program (HRRP) was established by the 2010 Patient Protection and Affordable Care Act (ACA) in an effort to reduce Ziedan, E. The Intended and Unintended Consequences of The Hospital Readmission Reduction Program. In addition, CMS reports hospitals HRRP data onthe, More information on past program policies and supplemental data files is available in the CMS, More information on the readmission measures is available in the, Supplemental data files from past program years are available from the, Hospital-Acquired Condition Reduction Program (HACRP), New Medical Services and New Technologies, Historical Impact Files for FY 1994 through Present, QualityNet: Hospital Readmissions Reduction Program, Hospital Readmissions Reduction Program (HRRP) Archives. The Healthcare Cost and Utilization Project (HCUP), HCUP NRD hospital identification number. The program has saved the CMS millions of dollars through reimbursement cuts as penalties as well as lower reimbursement to hospital visits because of prevented readmissions [18]. It is important to continue the research on HRRPs impact among different hospital types and patient groups (e.g., hospital ownership [17], safety-net status [8], and patient characteristics) over this longer period. Comorbidity measures for use with administrative data. For example, in hospitals with the smallest proportion of low-income patients (Group 1: lowest quartile in Table2), the Medicare AMI readmission decreased by 2.1 percentage points, from 17.4 to 15.3%. The ERR measures a hospitals relative performance and is aratio of the predicted-to-expected readmissions rates. The use of electronic medical records will support this effort by allowing information to be more easily shared and to provide continuity of care. Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. The payment adjustment factor is a weighted average of a hospitals performance across the readmission measures during the HRRP performance period. Alternatively, the difference between Medicare AMI and GI readmission rates before the HRRP is 0.041, whereas the post-HRRP difference is 0.027. 2017. https://doi.org/10.1177/1077558717744611. After the Review and Correction period, CMS reports HRRP data in the Inpatient Prospective Payment System/Long-Term Care Hospital Prospective Payment System Final Rule Supplemental Data File on CMS.gov. There are two exceptions from a readmission penalty: 1) readmission for certain staged AMI procedures likely planned during the index hospital inpatient admission, and 2) same-day hospital inpatient readmissions for the same condition to the same hospital. Readmission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems. This assumption might not hold true. 2016 Feb 1;54(2):16271. N Engl J Med. It is overseen by the Centers for Medicare & Medicaid Services (CMS) and encourages hospitals to reduce avoidable readmissions by improving care coordination and communication.. Zuckerman RB, Sheingold SH, Orav EJ, Ruhter J, Epstein AM. If cream-skimming were to occur, our estimates of the impact of HRRP would be biased, as some of the reductions in readmission rates could be attributed to cream-skimming. Then the DD estimates would overstate the effect of HRRP. Improved discharge planning, education and follow-up for discharged patients are also key factors to reduce readmissions. Healthcare Cost and Utilization Project. WebIt passed AHA-supported legislation requiring Medicare to account for sociodemographic factors starting on Oct. 1, 2018. Health Serv Res. Launched in October 2012, the HRRP penalizes hospitals that have higher than expected readmission rates by reducing Medicare payments. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Hospital Readmissions Reduction Program (HRRP), Chronic obstructive pulmonary disease (COPD), Coronary artery bypass graft (CABG) surgery, Elective primary total hip arthroplasty and/or total knee arthroplasty (THA/TKA). Medicares Hospital Readmission Reduction Program 26 April 2018. https://catalyst.nejm.org/hospital-readmissions-reduction-program-hrrp/ Accessed 24 July 2019. If the rates of readmissions to a discharging, or another Inpatient Prospective Payment System (IPPS) hospital were deemed excessive, the hospitals IPPS payments were decreased for all Medicare payments. Medicare Hospital Readmissions Reduction Program | Health Affairs The disparity in readmission rates between vulnerable and less vulnerable groups remained for other index hospitalizations as well. and Plug-Ins, Hospital Readmissions Reduction Program (HRRP), Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Bypass Graft (CABG) Surgery, Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA). Privacy Although studies have examined the policys overall impacts and differences by hospital types, research is limited on its effects for different types of vulnerable populations. A new set of unique IDs is created each year in NRD. Following the CMS definition, we excluded admissions for patients who died during hospitalization, were discharged against medical advice, or were transferred to another acute care facility. Through the Hospital Readmission Reduction Program, the Centers for Medicare & Medicaid Services penalizes hospitals for excess readmissions when compared to expected levels of readmissions. The Hospital Readmissions Reduction Program Learning A 2017 study using 20082014 Virginia hospital data found a decrease in AMI readmissions as well as no changes in the age, race/ethnicity, health status, and socioeconomic status of patients admitted for AMI [7]. 2017;26(8):103751. The Hospital Readmissions Reduction Program (HRRP) was established by the 2010 Patient Protection and Affordable Care Act in an effort to reduce excess hospital readmissions, lower health care costs, and improve patient safety and outcomes. Second, in Additional files 1 and 2: Appendices A and B we estimated DDD models. 2015;50(1):2039. ED physicians should be proactive with the hospitals and medical staffs to develop programs and processes to address these readmissions. Socio-demographic and -economic factors associated with 30-day When the program was implemented, about 20% of Medicare patients were readmitted to a hospital within one month of discharge; CMS considered this number excessive and believed that readmissions are an indicator of quality of care, or lack thereof. For heart attack, heart failure and pneumonia patients, expected Who and where are Kentuckys remaining uninsured? The conclusions are comparable. However, they confirm significant effects of the HRRP on reducing Medicare AMI readmissions in low-income hospitals and hospitals that treat a high percentage of Medicaid patients. Not only has the HRRP made a difference for targeted populations and conditions, but it has also reduced readmissions for other non-targeted patients (e.g., AMI patients with private insurance). We use the excess readmission ratio (ERR) toassess hospital performance. Barnett ML, Hsu J, McWilliams JM. The Hospital Readmission Reductions Program (HRRP), a national value-based program that aimed to incentivize improvements in care delivery by penalizing 2014;49(3):81837. Individuals and families either apply for eligible public insurance such as Medicare, Medicaid and the State Childrens Health Insurance Program (SCHIP) or purchase private insurance plans through their employers or in the insurance market. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, CMS Hospital Readmissions Reduction Program, QualityNet Hospital Readmissions Reduction Program, Help with File Formats Payment reductions are applied to all Medicare fee-for-service base operating diagnosis-related group payments during the FY (October 1 to September 30). Table1 uses the pre- and post-HRRP readmission rates for a treatment group (Medicare AMI patients) and a control group (Medicare GI patients) to illustrate the DD approach. 1343, which would address the need for a sociodemographic adjustment. The aim of this study was to analyze the impact of the HRRP on readmissions for three targeted conditions (acute myocardial infarction, heart failure, and pneumonia) among four types of vulnerable populations, including low-income patients, patients served by hospitals that serve a high percentage of low-income or Medicaid patients, and high-risk patients at the highest quartile of the Elixhauser comorbidity index score. Other studies [7, 14] are more recent but focus on smaller state-level data sets. Unlike the state-level data used in previous studies [7, 14], the hospital identifiers in NRD do not track the same hospital across the years, as mentioned earlier. Finally, like many studies on this topic, we focus on the programs short-term effect. CMS determined the excess readmission ratios for the three diagnoses or measures based on a National Quality Forum (NQF) endorsed methodology; the analysis process and methodology are complex and looked at three years of discharge data and at least 25 records for each condition. The 2010 ACA was a major health care reform in the U.S. to address the two problems, and the HRRP is one of many programs to improve the efficiency in the U.S. health care system. 2012 Apr 12;366(15):1366-9. doi: 10.1056/NEJMp1201598. 2016;316(24):264756. This study used the DD framework, a popular method in evaluating public policies. There are several policy implications both broad and limited to the HRRP. Our main conclusions on the impact of HRRP on Medicare AMI readmission rates are robust as indicated by the results from two DDD frameworks presented in Additional files 1 and 2: Appendices A and B, despite the data-imposed limitation that the separation of hospitals into at-risk and not-at-risk categories needs to be done year-by-year. Before 2012 (during the pre-HRRP period), Medicare GI, AMI, HF and PN rates had been decreasing slightly at about the same rate. 2011 https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/downloads/MMSHospital-WideAll-ConditionReadmissionRate.pdf Accessed 15 Nov 2018. Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries. Results. Individual hospital rates can be found at CMS Hospital Compare Website: http://www.medicare.gov/hospitalcompare/search.html?AspxAutoDetectCookieSupport=1, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HRRP-Archives. The AHA continues to urge other improvements to the HRRP, such as using more accurate measures and updating the penalty formula to ensure it provides the right incentive to improve. We are thus unable to stratify samples based on expansion status. WebHF is the leading cause of readmissions in patients age 65 years with high associated societal and economic costs. The reduction was the largest for upper-middle income patients and high-risk patients. Hospital Readmissions Reduction Program (HRRP) | NEJM Catalyst All Medicare payments to an affected hospital will be reduced. Unfortunately, the NRD does not track hospitals across years, and hospital state information is not available [30, 31]. It would be a problem if risky patients were never admitted by any hospital or if the travel time and other related expenses for patients increased. These short- and long-term evaluations and close examinations are especially important nowadays given the uncertainty surrounding the ACA. For each of the index hospitalizations (AMI, HF or PN) based on a patients principle ICD-9 codes as outlined in the CMS reports, a corresponding 30-day readmission indicator was set to one if readmission (for any conditions, except planned visits or procedures) occurred within 30days of discharge. First, we do not have a way of observing the specific mechanisms that drive the readmission processes at the hospital level. CMS sends confidential Hospital-Specific Reports (HSRs) to hospitals annually. the payment reduction CMS uses to reduce hospital payments. However, it is possible that hospitals, patients and insurance companies had already made changes during or before 2014. Others use descriptive statistics [13] or interrupted time series (ITS) models to compare trends [12]. Exemption as granted by the Babson College Institutional Review Board. With linked hospital IDs across years, future studies can test the cream-skimming hypothesis, study the changes of hospital baseline characteristics, and include fixed effects in models. Compared to other countries, the U.S. spends the most on health care but often ranks far behind in health outcomes such as immunization rates, obesity and life expectancy [34]. We list the following additional caveats in the interpretation of the results. Bethesda, MD 20894, Web Policies Google Scholar. The goal of this study is to examine whether observations about the effect of the HRRP on readmission rates translate to different types of populations. Figure2 shows the readmission trends for Medicare patients with the index conditions compared to private insurance patients of 45+ years of age with the same index conditions. We suggest using these estimates with caution when deciding what types of SNFs suggest to a patient after hospital discharge. Third, there is a possibility of cream-skimming, i.e., hospitals taking on fewer risky patients after the HRRP. Brown, Bipartisan Group of Senators Introduce statement and Heres how you know. .gov Gorodeski EZ, Starling RC, Blackstone EH. Article Med Care. Terms and Conditions, We also note that hospital attributes could change as a response to HRRP or other policies such as Medicaid expansion. The program is part of CMS goal to transition to value-based purchasing--paying for care based on quality and not just quantity. Share sensitive information only on official, secure websites. On the whole, the HRRP has been deemed a success at both the local and the national levels. From 2007 to 2015, readmission rates for targeted conditions declined from 21.5% to 17.8%, and rates for December 2018. https://www.modernhealthcare.com/article/20181219/NEWS/181219885/aca-repeal-wouldn-t-stop-transition-to-value-based-payment-efforts-to-lower-drug-spending Accessed 29 Sep 2019.

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