Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions
Benjamin Y Li1, Kenneth L Urish2, Bruce L Jacobs3
1Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor.
Insights
Higher-volume hospitals showed a trend toward lower readmission penalties under the Hospital Readmissions Reduction Program (HRRP) for hip and knee replacements. However, these associations were not statistically significant, indicating no major differences in patient or hospital characteristics.
Area of Science:
- Health Policy
- Orthopedic Surgery
- Healthcare Quality
Background:
- The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for excess readmissions in specific conditions.
- Understanding factors influencing surgical penalties is crucial for improving care.
Purpose of the Study:
- To examine the first year of HRRP penalties for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- To investigate the association between hospital volume and readmission penalties.
Main Methods:
- Data from FY2015 HRRP, American Hospital Association Survey, and Florida's Healthcare Cost and Utilization Project were linked.
- A case-control framework compared hospitals based on HRRP penalty severity for THA and TKA.
- Analysis included 60,663 Medicare patients from 143 Florida hospitals.
Main Results:
- 4.9% of patients (2991/60,663) undergoing THA or TKA were readmitted within 30 days.
- Higher annual hospital arthroplasty volume showed a non-significant inverse association with readmission rates and HRRP penalties.
- Hospital and patient characteristics were similar across penalty severity levels.
Conclusions:
- Higher-volume hospitals trended towards less severe readmission penalties for THA/TKA, but differences were not statistically significant.
- No systematic differences were observed in readmitted patients across penalty severities.
Importance:
The Hospital Readmissions Reduction Program (HRRP) is a Centers for Medicare and Medicaid Services policy that levies hospital reimbursement penalties based on excess readmissions of patients with 4 medical conditions and 3 surgical procedures. A greater understanding of factors associated with the 3 surgical reimbursement penalties is needed for clinicians in surgical practice.
Objective:
To investigate the first year of HRRP readmission penalties applied to 2 surgical procedures-elective total hip arthroplasty (THA) and total knee arthroplasty (TKA)-in the context of hospital and patient characteristics.
Design, Setting, And Participants:
Fiscal year 2015 HRRP penalization data from Hospital Compare were linked with the American Hospital Association Annual Survey and with the Healthcare Cost and Utilization Project State Inpatient Database for hospitals in the state of Florida. By using a case-control framework, those hospitals were separated based on HRRP penalty severity, as measured with the HRRP THA and TKA excess readmission ratio, and compared according to orthopedic volume as well as hospital-level and patient-level characteristics. The first year of HRRP readmission penalties applied to surgery in Florida Medicare subsection (d) hospitals was examined, identifying 60 663 Medicare patients who underwent elective THA or TKA in 143 Florida hospitals. The data analysis was conducted from February 2016 to January 2017.
Exposures:
Annual hospital THA and TKA volume, other hospital-level characteristics, and patient factors used in HRRP risk adjustment.
Main Outcomes And Measures:
The HRRP penalties with HRRP excess readmission ratios were measured, and their association with annual THA and TKA volume, a common measure of surgical quality, was evaluated. The HRRP penalties for surgical care according to hospital and readmitted patient characteristics were then examined.
Results:
Among 143 Florida hospitals, 2991 of 60 663 Medicare patients (4.9%) who underwent THA or TKA were readmitted within 30 days. Annual hospital arthroplasty volume seemed to follow an inverse association with both unadjusted readmission rates (r = -0.16, P = .06) and HRRP risk-adjusted readmission penalties (r = -0.12, P = .14), but these associations were not statistically significant. Other hospital characteristics and readmitted patient characteristics were similar across HRRP orthopedic penalty severity.
Conclusions And Relevance:
This study's findings suggest that higher-volume hospitals had less severe, but not significantly different, rates of readmission and HRRP penalties, without systematic differences across readmitted patients.
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