Relative Effects of the Hospital Readmissions Reduction Program on Hospitals That Serve Poorer Patients

Importance: Hospitals that serve poorer populations have higher readmission rates. It is unknown whether these hospitals effectively lowered readmission rates in response to the Hospital Readmissions Reduction Program (HRRP). Objective: To compare pre-post differences in readmission rates among hospitals with different proportion of dual-eligible patients both generally and among the most highly penalized (ie, low performing) hospitals. Design: Retrospective cohort study using piecewise linear model with estimated hospital-level risk-standardized readmission rates (RSRRs) as the dependent variable and a change point at HRRP passage (2010). Economic burden was assessed by proportion of dual-eligibles served. Setting: Acute care hospitals within the United States. Participants: Medicare fee-for-service beneficiaries aged 65 years or older discharged alive from January 1, 2003 to November 30, 2014 with a principal discharge diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia. Main Outcome and Measure: Decrease in hospital-level RSRRs in the post-law period, after controlling for the pre-law trend. Results: For AMI, the pre-post difference between hospitals that service high and low proportion of dual-eligibles was not significant (−65 vs. −64 risk-standardized readmissions per 10000 discharges per year, P=0.0678). For CHF, RSRRs declined more at high than low dual-eligible hospitals (−79 vs. −75 risk-standardi...
Source: Medical Care - Category: Health Management Tags: Original Articles Source Type: research