Decreases In Readmissions Credited To Medicare’s Program To Reduce Hospital Readmissions Have Been Overstated

Medicare's Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a concurrent change in electronic tra...

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Vydáno v:Health Affairs Ročník 38; číslo 1; s. 36 - 43
Hlavní autoři: Ody, Christopher, Msall, Lucy, Dafny, Leemore S., Grabowski, David C., Cutler, David M.
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States The People to People Health Foundation, Inc., Project HOPE 01.01.2019
Témata:
Acute services
Beneficiaries
Codes
Heart attacks
Heart failure
Hospitalization
Hospitals
Medical treatment
Medicare
Patient admissions
Patients
Pneumonia
Readmission
Reduction
Risk
Risk adjustment
Risk management
Risk reduction
Social programs
Statistical analysis
Statistical methods
Time series
ISSN:0278-2715, 2694-233X, 1544-5208, 2694-233X
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Abstract Medicare's Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a concurrent change in electronic transaction standards allowed hospitals to document a larger number of diagnoses per claim, which had the effect of reducing risk-adjusted patient readmission rates. Prior studies of the HRRP relied upon control groups' having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group. Accounting for the revised standards reduced the decline in risk-adjusted readmission rates for targeted conditions by 48 percent. After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples. Either the HRRP had no effect on readmissions, or it led to a systemwide reduction in readmissions that was roughly half as large as prior estimates have suggested.
AbstractList Medicare's Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a concurrent change in electronic transaction standards allowed hospitals to document a larger number of diagnoses per claim, which had the effect of reducing risk-adjusted patient readmission rates. Prior studies of the HRRP relied upon control groups' having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group. Accounting for the revised standards reduced the decline in risk-adjusted readmission rates for targeted conditions by 48 percent. After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples. Either the HRRP had no effect on readmissions, or it led to a systemwide reduction in readmissions that was roughly half as large as prior estimates have suggested.
Medicare's Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a concurrent change in electronic transaction standards allowed hospitals to document a larger number of diagnoses per claim, which had the effect of reducing risk-adjusted patient readmission rates. Prior studies of the HRRP relied upon control groups' having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group. Accounting for the revised standards reduced the decline in risk-adjusted readmission rates for targeted conditions by 48 percent. After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples. Either the HRRP had no effect on readmissions, or it led to a systemwide reduction in readmissions that was roughly half as large as prior estimates have suggested.
Medicare's Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a concurrent change in electronic transaction standards allowed hospitals to document a larger number of diagnoses per claim, which had the effect of reducing risk-adjusted patient readmission rates. Prior studies of the HRRP relied upon control groups' having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group. Accounting for the revised standards reduced the decline in risk-adjusted readmission rates for targeted conditions by 48 percent. After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples. Either the HRRP had no effect on readmissions, or it led to a systemwide reduction in readmissions that was roughly half as large as prior estimates have suggested.Medicare's Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a concurrent change in electronic transaction standards allowed hospitals to document a larger number of diagnoses per claim, which had the effect of reducing risk-adjusted patient readmission rates. Prior studies of the HRRP relied upon control groups' having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group. Accounting for the revised standards reduced the decline in risk-adjusted readmission rates for targeted conditions by 48 percent. After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples. Either the HRRP had no effect on readmissions, or it led to a systemwide reduction in readmissions that was roughly half as large as prior estimates have suggested.
Author Dafny, Leemore S.
Ody, Christopher
Cutler, David M.
Grabowski, David C.
Msall, Lucy
Author_xml – sequence: 1
  givenname: Christopher
  surname: Ody
  fullname: Ody, Christopher
  organization: Christopher Ody is a research assistant professor in the Kellogg School of Management, Northwestern University, in Evanston, Illinois
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  givenname: Lucy
  surname: Msall
  fullname: Msall, Lucy
  organization: Lucy Msall is a PhD candidate in the Booth School of Business, University of Chicago, in Illinois
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  givenname: Leemore S.
  surname: Dafny
  fullname: Dafny, Leemore S.
  organization: Leemore S. Dafny is the MBA Class of 1960 Professor of Business Administration at Harvard Business School, in Boston, Massachusetts
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  givenname: David C.
  surname: Grabowski
  fullname: Grabowski, David C.
  organization: David C. Grabowski is a professor in the Department of Health Care Policy, Harvard Medical School, in Boston
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  givenname: David M.
  surname: Cutler
  fullname: Cutler, David M.
  organization: David M. Cutler is the Otto Eckstein Professor of Applied Economics in the Department of Economics at Harvard University and a research associate at the National Bureau of Economic Research, both in Cambridge, Massachusetts
BackLink https://www.ncbi.nlm.nih.gov/pubmed/30615522$$D View this record in MEDLINE/PubMed
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Snippet Medicare's Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general...
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StartPage 36
SubjectTerms Acute services
Beneficiaries
Codes
Heart attacks
Heart failure
Hospitalization
Hospitals
Medical treatment
Medicare
Patient admissions
Patients
Pneumonia
Readmission
Reduction
Risk
Risk adjustment
Risk management
Risk reduction
Social programs
Statistical analysis
Statistical methods
Time series
Title Decreases In Readmissions Credited To Medicare’s Program To Reduce Hospital Readmissions Have Been Overstated
URI https://www.ncbi.nlm.nih.gov/pubmed/30615522
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Volume 38
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