Readmission reduction push shows promising results

Despite considerable criticism regarding the Hospital Readmissions Reduction Program (HRRP), the initiative is largely doing the job that the Affordable Care Act created it to do, according to a new study published in Health Affairs.

The Centers for Medicare & Medicaid Services hit more than 2,600 hospitals with financial penalties last year for their high readmission rates and increased the penalty ceiling from 1 percent to 3 percent of reimbursements, FierceHealthcare has reported. Overall, CMS has withheld $935 million in reimbursements from hospitals since it debuted the financial penalties in 2012, according to Health Affairs.

In the study, researchers examined changes from 2008 through 2012 in 30-day admission rates among Medicare patients in New York state who were admitted for heart attack, heart failure and pneumonia, as well as privately insured patients admitted for the same three conditions and Medicare patients hospitalized for other conditions.

The study found that 30-day readmissions declined by 1.3 percentage points for the three targeted conditions during the study period, during which the authors theorized hospitals would start to respond to the HRRP. Readmissions fell 1 percentage point for other non-targeted conditions, a finding the authors say is most likely due to a spillover effect of hospitals undertaking more general readmission reduction strategies that affect more than just the HRRP-targeted conditions.

The study did not find statistically significant changes in readmissions for privately insured patients during the same time period. The authors also wrote that they "did not find any strong evidence" that hospitals were intentionally treating Medicare patients in alternative ways--such as treating readmitted patients as outpatients in the emergency department--in order to avoid the program's penalties.

However, the research does acknowledge the troubling rise in hospitals' use of observation status, which some have said is an attempt to game the system that ends up burdening patients with high out-of-pocket costs. And another study published in the same issue of Health Affairs found that long-term care hospitals frequently time patient discharges in order to reap maximum reimbursements.

"Reducing unnecessary hospital readmissions is a promising avenue for large-scale savings, and the results of this early assessment of the Hospital Readmissions Reduction Program suggest that the program is impacting hospitals in the direction intended by the ACA in one large state," the authors conclude.

Other recent research and industry groups don't share the same rosy view of the HRRP. A study published last week found that the current Medicare measure for readmissions doesn't accurately reflect hospitals' accountability for rehospitalization, as risk factors for readmissions change considerably during the 30 days after discharge. And the American Hospital Association has been vocal about the need for the HRRP to control for sociodemographic factors that it says can unfairly penalize hospitals.

To learn more:
- check out the study (subscription required)

Related Articles:
30-day readmission measure fails to account for changing risk factors
Readmission penalties reach record high
AHA calls for changes in hospital readmission penalties
Optimize patient flow: The key to reducing readmissions
Readmission reduction: A losing battle?
3 ways to make readmission policies fair for hospitals

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