MedicalResearch.com Interview with:
Nihar R. Desai, MD, MPH
Assistant Professor of Medicine
Section of Cardiovascular Medicine, Yale School of Medicine
Center for Outcomes Research and Evaluation
Yale New Haven Health System
MedicalResearch.com: What is the background for this study?
Response: Reducing rates of readmissions after hospitalization has been a major focus for patients, providers, payers, and policymakers because they reflect, at least partially, the quality of care and care transitions, and account for substantial costs. The Hospital Readmission Reduction Program (HRRP) was enacted under Section 3025 of the Patient Protection and Affordable Care Act (ACA) in March 2010 and imposed financial penalties beginning in October 2012 for hospitals with higher than expected readmissions for acute myocardial infarction (AMI), congestive heart failure (HF), and pneumonia among their fee-for-service Medicare beneficiaries. In recent years, readmission rates have fallen nationally, and for both target (AMI, HF, pneumonia) and non-target conditions.
We were interested in determining whether the Hospital Readmission Reduction Program (HRRP) associated with different changes in readmission rates for targeted and non-targeted conditions for penalized vs non-penalized hospitals?
MedicalResearch.com: What are the main findings?
Response: The main findings from this longitudinal cohort study of 48,137,102 hospitalizations among 20,351,161 Medicare fee-for-service patients across 3497 hospitals, are that announcement of the HRRP was associated with significant reductions in readmissions at hospitals later subject to penalties, with significantly larger reductions for target conditions.
In contrast, hospitals not subject to financial penalties experienced comparable reductions in readmissions for target and non-target conditions.
Finally, readmission rates plateaued across all hospitals after implementation of the HRRP implementation.
MedicalResearch.com: What should readers take away from your report?
Response: Our analysis demonstrates that the significant reductions in readmission observed after announcement of financial penalties under the HRRP program occurred primarily at hospitals that were subject to financial penalties. Still further, we found that readmission rates for target conditions declined significantly more than rates for non-target conditions at hospitals later subject to HRRP penalties, which suggests that these hospitals specifically focused efforts to improve readmission outcomes for patients admitted for these target conditions.
In contrast, at hospitals not subject to financial penalties, readmission rates for non-target conditions had declines comparable with those for target conditions, which suggests that broader, system-wide readmission reduction strategies were more likely to have been employed as opposed to strategies focusing solely on the target conditions.
Finally, across all hospitals, we found that readmission rates for target and non-target conditions have not significantly changed since October 2012.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: The question of whether additional reductions in readmission rates can be realized and if so, what policy and payment levers will be most effective in doing so remains an important priority for further study. In addition, it would be important to shed some further light on the specific strategies and performance improvement initiatives that hospitals employed to successfully reduce readmissions and how best these can be disseminated to hospitals who continue to lag behind.
MedicalResearch.com: Is there anything else you would like to add?
Response: The authors work under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are used for public reporting and payment programs. The sponsors had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation of the manuscript or decision to submit it for publication.
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Desai NR, Ross JS, Kwon JY, Herrin J, Dharmarajan K, Bernheim SM, Krumholz HM, Horwitz LI. Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions. JAMA. 2016;316(24):2647-2656. doi:10.1001/jama.2016.18533
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Nihar R. Desai, MD, MPH (2016). Hospital Readmissions Fell After Penalties Instituted But Then Plateaued MedicalResearch.com