Citation:
Abstract:
Background
Hospitals that serve poorer populations have higher readmission rates, perhaps due to social factors beyond their control. It is unknown whether such hospitals – particularly those with high baseline penalties – effectively lowered readmission rates for congestive heart failure in response to the Hospital Readmissions Reduction Program (HRRP).
Methods
Using the patients admitted with CHF, in the national Medicare Provider and Analysis Review (MedPAR) files from January 1, 2003 to November 30, 2014, we used a piecewise linear model with estimated hospital-level quarterly RSRRs as the dependent variable and a change point at HRRP passage (2010) to test 2 main hypotheses. First, for hospitals of low, average, and high economic burden as assessed by proportion of dual-eligibles served, we tested if RSRRs declined in the post-law period after controlling for the pre-law secular trend. Second, we tested if these pre-post differences were different among economic burden groups. To explore specific effects within the most highly penalized (ie, low performing) hospitals, we repeated the main analysis only among the 742 hospitals that received the highest penalties in the first year of the HRRP.
Results
For all economic burden groups, CHF readmission rates declined after the law relative to pre-law trends (p < 0.001 for all pre-post comparisons). RSRRs declined more at high economic burden hospitals than low economic burden hospitals (-79 vs. -75 risk-standardized readmissions per 10000 discharges per year, p = 0.0006). Among the 742 highest penalized hospitals and all conditions, the pre-post decline in rate of change of RSRRs was less for high economic burden hospitals than low economic burden hospitals (-88 vs. -97 for CHF, p < 0.01).
Conclusion
After the HRRP, RSRRs for congestive heart failure declined more at high economic burden hospitals than low economic burden hospitals. However, among high-penalty (low-performance) hospitals, RSRRs declined more for low economic burden hospitals compared with high economic burden hospitals. These results suggest that a specific group of high penalty, high economic burden hospitals may be less able to improve performance on readmission metrics.