Decreases In Readmissions Credited To Medicare's Program To Reduce Hospital Readmissions Have Been Overstated

Area of Science:

• Health Services Research
• Health Policy
• Healthcare Quality Improvement

Background:

• Medicare's Hospital Readmissions Reduction Program (HRRP) aimed to decrease patient readmissions for targeted conditions.
• Previous studies indicated HRRP success in lowering risk-adjusted readmission rates at general acute care hospitals.

Purpose of the Study:

• To re-evaluate the effectiveness of the HRRP by accounting for concurrent changes in electronic health record standards.
• To assess the true impact of HRRP on hospital readmission rates, independent of documentation changes.

Main Methods:

• Analyzed Medicare data, adjusting for changes in diagnosis documentation standards following revised electronic transaction standards.
• Compared readmission rate declines in HRRP-targeted conditions against control groups, adjusting for baseline readmission differences.

Main Results:

• Accounting for revised documentation standards reduced the observed decline in HRRP-targeted readmission rates by 48%.
• After adjusting for pre-HRRP readmission rates, declines for targeted conditions were statistically similar to control groups.
• The HRRP's effect on readmissions was either negligible or approximately half of previously estimated reductions.

Conclusions:

• The effectiveness of the Hospital Readmissions Reduction Program may be significantly overstated due to confounding factors.
• Policy evaluations must account for simultaneous changes in healthcare data reporting standards to accurately assess program impact.
• Further research is needed to determine the precise impact of HRRP and identify effective strategies for reducing hospital readmissions.