Did the Hospital Readmissions Reduction Program Reduce Readmissions? An Assessment of Prior Evidence and New...

Area of Science:

• Health Services Research
• Health Economics
• Public Health Policy

Background:

• The Hospital Readmissions Reduction Program (HRRP) aimed to decrease hospital readmissions through financial penalties.
• Previous evaluations of the HRRP have yielded mixed results regarding its effectiveness.
• Concerns exist regarding the validity of methodologies used in prior HRRP impact assessments.

Purpose of the Study:

• To empirically assess the causal effect of the HRRP on hospital readmissions.
• To evaluate the internal validity of common empirical approaches used to study the HRRP.
• To introduce and apply a regression-kink design for a novel analysis of HRRP's impact.

Main Methods:

• Utilized a regression-kink design, a previously unused approach for evaluating the HRRP.
• Critically assessed the internal validity of empirical methods employed in prior HRRP research.
• Validated the results obtained from the regression-kink analysis.

Main Results:

• Found that common empirical approaches for HRRP evaluation often lack internal validity.
• Results from the regression-kink analysis indicate the HRRP had a minimal effect on hospital readmissions.
• This contrasts with most prior studies reporting significant reductions in readmissions due to the HRRP.

Conclusions:

• The HRRP's effectiveness in reducing hospital readmissions is questionable.
• Methodological limitations in prior studies may explain discrepancies in findings.
• Challenges in identifying preventable readmissions and imperfect risk adjustment complicate HRRP's impact assessment.