Hospital Readmissions Reduction Program: Intended and Unintended Effects

This study examines whether the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excess readmissions for certain conditions, has reduced hospital readmissions and led to unintended consequences. Our analyses of Florida hospital administrative data between 2008 and 2014 find that the HRRP resulted in a reduction in the likelihood of readmissions by 1% to 2% for traditional Medicare (TM) beneficiaries with heart failure, pneumonia, or chronic obstructive pulmonary disease. Readmission rates for Medicare Advantage (MA) beneficiaries and privately insured patients with heart attack and heart failure decreased even more than TM patients with the same target condition (e.g., for heart attack, the likelihood for TM beneficiaries to be remitted is 2.2% higher than MA beneficiaries and 2.3% higher than privately insured patients). We do not find any evidence of cost-shifting, delayed readmission, or selection on discharge disposition or patient income. However, the HRRP reduced the likelihood of Hispanic patients with target conditions being admitted by 2% to 4%.

[1]  K. Carey,et al.  Readmissions To New York Hospitals Fell For Three Target Conditions From 2008 To 2012, Consistent With Medicare Goals. , 2015, Health affairs.

[2]  Thomas G McGuire,et al.  Prejudice, clinical uncertainty and stereotyping as sources of health disparities. , 2003, Journal of health economics.

[3]  R. Bhalla,et al.  Could Medicare Readmission Policy Exacerbate Health Care System Inequity? , 2010, Annals of Internal Medicine.

[4]  Adrian F Hernandez,et al.  Discharge to a Skilled Nursing Facility and Subsequent Clinical Outcomes Among Older Patients Hospitalized for Heart Failure , 2011, Circulation. Heart failure.

[5]  K A Schulman,et al.  The effect of race and sex on physicians' recommendations for cardiac catheterization. , 1999, The New England journal of medicine.

[6]  M. van Ryn,et al.  The effect of patient race and socio-economic status on physicians' perceptions of patients. , 2000, Social science & medicine.

[7]  Refining the Hospital Readmissions Reduction Program Refining the Hospital Readmissions Reduction Program Chapter Summary , 2022 .

[8]  Leora I. Horwitz,et al.  Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions. , 2016, JAMA.

[9]  Matthew D. McHugh,et al.  Medicare Readmissions Policies and Racial and Ethnic Health Disparities: A Cautionary Tale , 2010, Policy, politics & nursing practice.

[10]  C. Steiner,et al.  Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011 , 2006 .

[11]  J. Killian,et al.  Skilled Nursing Facility Use and Hospitalizations in Heart Failure: A COMMUNITY LINKAGE STUDY , 2017, Mayo Clinic proceedings.

[12]  Eric Rollins,et al.  Medicare readmission rates showed meaningful decline in 2012. , 2013, Medicare & medicaid research review.

[13]  D. Nerenz,et al.  Socioeconomic status and readmissions: evidence from an urban teaching hospital. , 2014, Health affairs.

[14]  H. Krumholz,et al.  Race, quality of care, and outcomes of elderly patients hospitalized with heart failure. , 2003, JAMA.

[15]  A. Ryan Has pay-for-performance decreased access for minority patients? , 2010, Health services research.

[16]  Leora I Horwitz,et al.  Changes in Discharge Location and Readmission Rates Under Medicare Bundled Payment. , 2016, JAMA internal medicine.

[17]  K. Grumbach,et al.  Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity. , 1999, American heart journal.

[18]  J. Mellor,et al.  Does It Pay to Penalize Hospitals for Excess Readmissions? Intended and Unintended Consequences of Medicare's Hospital Readmissions Reductions Program , 2017, Health economics.

[19]  Mark V. Williams,et al.  Hospital readmission as an accountability measure. , 2011, JAMA.

[20]  E John Orav,et al.  Readmissions, Observation, and the Hospital Readmissions Reduction Program. , 2016, The New England journal of medicine.

[21]  C. Lisk,et al.  Hospital short stay policy issues , 2014 .

[22]  Bernard Friedman,et al.  Racial/ethnic disparities in potentially preventable readmissions: the case of diabetes. , 2005, American journal of public health.

[23]  Corwin M Zigler,et al.  Readmission Rates After Passage of the Hospital Readmissions Reduction Program , 2017, Annals of Internal Medicine.