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Physician Financial Incentives to Reduce Unplanned Hospital Readmissions: an Interrupted Time Series Analysis
John A Staples1,2,3, Guiping Liu4, Jeffrey R Brubacher2,5
1Department of Medicine, University of British Columbia, Vancouver, Canada.
Insights
Financial incentives for physician-written discharge plans did not significantly reduce hospital readmissions in British Columbia. Incomplete physician uptake may have limited the policy's effectiveness in improving patient care transitions.
Area of Science:
- Health Services Research
- Health Economics
- Patient Care Management
Background:
- British Columbia's Ministry of Health implemented a $75 physician incentive in 2012 for written post-discharge care plans for complex patients.
- This policy aimed to improve care continuity and reduce hospital readmissions.
Purpose of the Study:
- To evaluate the impact of physician financial incentives on reducing 30-day unplanned hospital readmissions.
- To assess the association between the incentive policy and changes in readmission risk over time.
Main Methods:
- An interrupted time series analysis was conducted on population-based hospitalization data from British Columbia (2007–2017).
- The study analyzed monthly readmission rates before and after the policy's introduction.
- Incomplete incentive payment uptake was also examined.
Main Results:
- The policy introduction was not associated with a significant change in monthly hospital readmission risk.
- While there was a reduction in potentially inappropriate medication prescriptions for older patients, no improvements were seen in beta-blocker prescriptions or 30-day mortality.
- Physician uptake of the incentive payment was low, increasing from 6.4% to 23.5% over the study period.
Conclusions:
- The physician incentive payment policy did not lead to significant reductions in hospital readmission rates.
- Incomplete physician participation may have hindered the policy's effectiveness.
- Findings suggest policymakers should consider physician engagement when designing similar interventions.
Background:
In 2012, the Ministry of Health in British Columbia, Canada, introduced a $75 incentive payment that could be claimed by hospital physicians each time they produced a written post-discharge care plan for a complex patient at the time of hospital discharge.
Objective:
To examine whether physician financial payments incentivizing enhanced discharge planning reduce subsequent unplanned hospital readmissions.
Design:
Interrupted time series analysis of population-based hospitalization data.
Participants:
Individuals with one or more eligible hospitalizations occurring in British Columbia between 2007 and 2017.
Main Measures:
The proportion of index hospital discharges with subsequent unplanned hospital readmission within 30 days, as measured each month of the 11-year study interval. We used interrupted time series analysis to determine if readmission risk changed after introduction of the incentive payment policy.
Key Results:
A total of 40,588 unplanned hospital readmissions occurred among 409,289 eligible index hospitalizations (crude 30-day readmission risk, 9.92%). Policy introduction was not associated with a significant step change (0.393%; 95CI, - 0.190 to 0.975%; p = 0.182) or change-in-trend (p = 0.317) in monthly readmission risk. Policy introduction was associated with significantly fewer prescription fills for potentially inappropriate medications among older patients, but no improvement in prescription fills for beta-blockers after cardiovascular hospitalization and no change in 30-day mortality. Incentive payment uptake was incomplete, rising from 6.4 to 23.5% of eligible hospitalizations between the first and last year of the post-policy interval.
Conclusion:
The introduction of a physician incentive payment was not associated with meaningful changes in hospital readmission rate, perhaps in part because of incomplete uptake by physicians. Policymakers should consider these results when designing similar interventions elsewhere.
Trial Registration:
ClinicalTrials.gov ID, NCT03256734.
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