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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Bibliographic Details
Published in:Health Affairs Vol. 38; no. 1; pp. 36 - 43
Main Authors: Ody, Christopher, Msall, Lucy, Dafny, Leemore S., Grabowski, David C., Cutler, David M.
Format: Journal Article
Language:English
Published: United States The People to People Health Foundation, Inc., Project HOPE 01.01.2019
Subjects:
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
Online Access:Get full text
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Summary: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.
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ISSN:0278-2715
2694-233X
1544-5208
2694-233X
DOI:10.1377/hlthaff.2018.05178