3 years ago

Effect of a Hospital-wide Measure on the Readmissions Reduction Program

Background

The Hospital Readmissions Reduction Program penalizes hospitals that have high 30-day readmission rates across specific conditions. There is support for changing to a hospital-wide readmission measure to broaden hospital eligibility and provide incentives for improvement across more conditions.

Methods

We used Medicare claims from 2011 through 2013 to evaluate the number of hospitals that were eligible for penalties, in that they met a volume threshold of 25 admissions over a 3-year period for a specific condition or 25 admissions over a 1-year period for the cohorts included in the hospital-wide measure. We estimated the expected effects that changing from the condition-specific readmission measures to a hospital-wide measure would have on average penalties for safety-net hospitals (i.e., hospitals that treat a large proportion of low-income patients) and other hospitals.

Results

Our sample included 6,807,899 admissions for the hospital-wide measure and 4,392,658 admissions for the condition-specific measures. Of 3443 hospitals, 688 were considered to be safety-net hospitals. Changing to the hospital-wide measure would result in 76 more hospitals being eligible to receive penalties. The hospital-wide measure would increase penalties (mean [±SE] Medicare payment reductions across all hospitals) from 0.42±0.01% to 0.89±0.01% of Medicare base diagnosis-related-group payments. It would also increase the disparity in penalties between safety-net hospitals and other hospitals from −0.03±0.02 to 0.41±0.06 percentage points.

Conclusions

A transition to a hospital-wide readmission measure would only modestly increase the number of hospitals eligible for penalties and would substantially increase the penalties for safety-net hospitals.

Supported by the Department of Health and Human Services, where all of the authors were employed at the time the research was initiated. This research received no external sources of support.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

The findings and conclusions in this article are those of the authors and do not represent the official position of the Department of Health and Human Services.

Source Information

From the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, DC (R.B.Z., K.E.J.M., S.H.S., L.M.C.); Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital — both in Boston (K.E.J.M., A.M.E.); and the Division of Internal Medicine, Department of Internal Medicine, Center for Healthcare Outcomes and Policy, and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (L.M.C.).

Address reprint requests to Dr. Epstein at .

Publisher URL: http://www.nejm.org/doi/full/10.1056/NEJMsa1701791

DOI: 10.1056/NEJMsa1701791

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