Jason H. Wasfy, MD, MPhil; Corwin Matthew Zigler, PhD; Christine Choirat, PhD; Yun Wang, PhD; Francesca Dominici, PhD; Robert W. Yeh, MD, MSc
Acknowledgment: The authors thank Elizabeth Laikhter and Linda Valsdottir for their assistance in editing the manuscript. Drs. Dominici and Yeh affirm that everyone who contributed significantly to the work is listed.
Grant Support: Funded in part by the National Institutes of Health (P01 CA134294, R01 GM111339, and R01 ES024332 [Dr. Dominici] and K23 HL 118138-01 [Dr. Yeh]) and the Hassenfeld Scholars Program of the Cardiology Division at Massachusetts General Hospital.
Disclosures: Dr. Wasfy reports salary support from the Massachusetts General Physicians Organization. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0185.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol, statistical code, and data set: See the Appendix. Further requests can be sent to the authors (e-mail, email@example.com).
Requests for Single Reprints: Francesca Dominici, PhD, Office of the Dean and Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, or Robert W. Yeh, MD, MSc, The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, Boston, MA 02215.
Current Author Addresses: Dr. Wasfy: Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
Drs. Zigler, Choirat, and Wang: Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115.
Dr. Dominici: Office of the Dean and Department of Biostatistics, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115.
Dr. Yeh: The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, 375 Longwood Avenue, Boston, MA 02215.
Author Contributions: Conception and design: J.H. Wasfy, F. Dominici, R.W. Yeh.
Analysis and interpretation of the data: J.H. Wasfy, C.M. Zigler, C. Choirat, Y. Wang, F. Dominici, R.W. Yeh.
Drafting of the article: J.H. Wasfy, C. Choirat, F. Dominici, R.W. Yeh.
Critical revision of the article for important intellectual content: J.H. Wasfy, Y. Wang, R.W. Yeh.
Final approval of the article: J.H. Wasfy, C.M. Zigler, C. Choirat, Y. Wang, F. Dominici, R.W. Yeh.
Statistical expertise: J.H. Wasfy, C.M. Zigler, C. Choirat, Y. Wang, F. Dominici.
Obtaining of funding: F. Dominici, R.W. Yeh.
Administrative, technical, or logistic support: F. Dominici, R.W. Yeh.
Collection and assembly of data: J.H. Wasfy, C. Choirat, Y. Wang.
Whether hospitals with the highest risk-standardized readmission rates (RSRRs) subsequently experienced the greatest improvement after passage of the Medicare Hospital Readmissions Reduction Program (HRRP) is unknown.
To evaluate whether passage of the HRRP was followed by acceleration in improvement in 30-day RSRRs after hospitalizations for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia and whether the lowest-performing hospitals had faster acceleration in improvement after passage of the law than hospitals that were already performing well.
Pre–post analysis stratified by hospital performance groups.
U.S. acute care hospitals.
15 170 008 Medicare patients discharged alive from 2000 to 2013.
Passage of the HRRP.
30-day readmission rates after hospitalization for AMI, CHF, or pneumonia for hospitals in the highest-performance (0% penalty), average-performance (>0% and <0.50% penalty), low-performance (≥0.50% and <0.99% penalty), and lowest-performance (≥0.99% penalty) groups.
Of 2868 hospitals serving 1 109 530 Medicare discharges annually, 30.1% were highest performers, 44.0% were average performers, 16.8% were low performers, and 9.0% were lowest performers. After controlling for prelaw trends, an additional 67.6 (95% CI, 66.6 to 68.4), 74.8 (CI, 74.0 to 75.4), 85.4 (CI, 84.0 to 86.8), and 95.1 (CI, 92.6 to 97.5) readmissions per 10 000 discharges were found to have been averted per year in the highest-, average-, low-, and lowest-performance groups, respectively, after passage of the law.
Inability to distinguish between improvement caused by the magnitude of the penalty or by different levels of health improvement in different patient populations.
After passage of the HRRP, 30-day RSRRs for myocardial infarction, heart failure, and pneumonia decreased more rapidly than before the law's passage. Improvement was most marked for hospitals with the lowest prelaw performance.
National Institutes of Health.
Wasfy JH, Zigler CM, Choirat C, et al. Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre–Post Analysis. Ann Intern Med. [Epub ahead of print 27 December 2016]166:324–331. doi: 10.7326/M16-0185
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Published: Ann Intern Med. 2017;166(5):324-331.
Published at www.annals.org on 27 December 2016
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