why was the hospital readmissions reduction program establishedsales compensation surveys

For the fourth definition of vulnerability, patients in each year were divided into four groups by the quartiles of their Elixhauser mortality index scores [21,22,23]. A more common window, especially in lieu of the Hospital Readmissions Reduction Program, Reducing readmissions improves quality and reduces spending. Any-target readmissions took the value of one if a patient had an either AMI, HF or PN 30-day readmission; and zero otherwise. Thirty-day readmissions--truth and consequences. 1, we show the trend in readmission rates for 20102014 for all patients and conditions in the sample (as a benchmark) as well as separately for Medicare AMI, HF, PN, and GI patients. Then the DD estimates would overstate the effect of HRRP. Several studies rely on difference-in-difference (DD) design [7, 10, 11] or triple difference (DDD) design [7, 14, 16]. 2023 Mar 6;23(1):213. doi: 10.1186/s12913-023-09193-1. However, they confirm significant effects of the HRRP on reducing Medicare AMI readmissions in low-income hospitals and hospitals that treat a high percentage of Medicaid patients. December 2018. https://www.modernhealthcare.com/article/20181219/NEWS/181219885/aca-repeal-wouldn-t-stop-transition-to-value-based-payment-efforts-to-lower-drug-spending Accessed 29 Sep 2019. It would be a problem if risky patients were never admitted by any hospital or if the travel time and other related expenses for patients increased. The results in Table 4 are somewhat encouraging when it comes to vulnerable populations. 2018. https://wsbfiles.wsb.wisc.edu/digital/rjbatt/intellcont_journal/Quality_Improvement_Spillovers%2003-2018-2.pdf Accessed 15 Nov 2018. An official website of the United States government Under the 2010 ACA, the Centers for Medicare and Medicaid Services launched many P4P programs, of which the most influential hospital programs are the HRRP, Hospital Value-Based Purchasing Program (HVBPP), and Hospital-Acquired Condition Reduction Program (HACRP). A recent study [6] used Medicare administrative claims data from July 2007 to June 2010 to analyze the range and distribution of readmissions by patients socioeconomic status. 2023 by the American Hospital Association. Definitions 1 and 2 describe a hospitals socioeconomic status, whereas definitions 3 and 4 describe a patients socioeconomic status and health condition in terms of comorbidity and mortality risk. The Hospital Readmissions Reduction Program - Time for Hospital readmission 2010 Jul 15;363(3):297-8. doi: 10.1056/NEJMc1001882. Hospital characteristics included their teaching status, control type (public or private), bed size (small, medium or large), and urban-rural location. lock During the same period, Medicare GI readmissions decreased by 0.5 percentage points. These changes could affect readmission rates. When it comes to patients comorbidities, high-risk patients in all index hospitalizations gained the most reduction in readmissions relative to Medicare GI patients. Elixhauser A, Steiner C, Harris DR, Coffey RM. Appendix B: Alternative DDD Analysis and Robustness Check. Following the CMS definition, we excluded admissions for patients who died during hospitalization, were discharged against medical advice, or were transferred to another acute care facility. Birmingham LE, Oglesby WH. Accessibility However, the readmission rate reductions for Medicare HF, PN, or All-Target patients relative to Medicare GI patients were larger for high-income hospitals than for low-income hospitals. These short- and long-term evaluations and close examinations are especially important nowadays given the uncertainty surrounding the ACA. 2010 measures maintenance technical report: acute myocardial infarction, heart failure, and pneumonia 30-day risk-standardized mortality measures. For the first type of vulnerable population, patients were divided into four groups according to their income level. The large sample allows us to conduct an in-depth analysis of the impact of HRRP on the patient and hospital subgroups. That means handling stress, getting good women's health care, and nurturing yourself. It is also important to examine whether the reductions in readmission rates are sustainable or whether hospitals have reached their limit. Specific coding or payment related issues should be directed to the payer.For information about this FAQ/Pearl, or to provide feedback, please contact David A. McKenzie, ACEP Reimbursement Director at (469) 499-0133 ordmckenzie@acep.org. Advocacy Fact Sheets The Issue The Affordable Care Act (ACA) required the Centers for Medicare & Medicaid Services (CMS) to penalize hospitals for excess This program, effective October 1, 2012, was designed to provide incentives for hospitals to implement strategies to reduce the number of costly and unnecessary hospital readmissions. Patients of low socioeconomic status measured by the median household income in the Zip Code of their residence. In addition, CMS reports hospitals HRRP data onthe, More information on past program policies and supplemental data files is available in the CMS, More information on the readmission measures is available in the, Supplemental data files from past program years are available from the, Hospital-Acquired Condition Reduction Program (HACRP), New Medical Services and New Technologies, Historical Impact Files for FY 1994 through Present, QualityNet: Hospital Readmissions Reduction Program, Hospital Readmissions Reduction Program (HRRP) Archives. Because Medicaid expansion took effect in 2014, our paper and other studies on HRRP [7, 8, 14, 28, 29] generally chose the sample period up to 2014 to avoid this potential problem. There is also evidence of spillover effects for non-targeted conditions among Medicare patients compared to privately insured patients. means youve safely connected to the .gov website. Moore BJ, White S, Washington R, Coenen N, Elixhauser A. Identifying increased risk of readmission and in-hospital mortality using hospital administrative data. A Decade of Observing the Hospital Readmission Planned readmissions, defined as intentional readmission within 30 days of discharge from an acute care hospital that is a scheduled part of the patients plan of care do not count as readmissions [20]. Sheehy AM, Locke CFS, Bonk N, Hirsch RL, Powell WR. Webthe Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, S. 688/H.R. 2016;35(8):146170. An important future research direction is to examine the possibility of cream-skimming and, if it did occur, how it would affect the evaluation of the HRRP and the implications for patients, caretakers, and policymakers. These changes are published annuallyafter a public comment period, with the Inpatient Prospective Payment System /Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS) Final Rule. It passed AHA-supported legislation requiring Medicare to account for sociodemographic factors starting on Oct. 1, 2018. We use DD models to control for these factors. Health Serv Res. Social Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults. They found little differences in readmission rates between hospitals serving large and small proportions of patients with low socioeconomic status. The rate of reduction for both Medicare Target and Medicare NonTarget conditions is higher than for private insurance. We also note that hospital attributes could change as a response to HRRP or other policies such as Medicaid expansion. Affordable Care Act (ACA) Section 3025 expansion of a field in the Intended and unintended consequences of Medicares hospital readmissions reductions program. This guide provides key facts and practical tips on women's health. 2014;49(3):81837. Share sensitive information only on official, secure websites. The DD estimates from Table 4 could be biased if other factors unrelated to the HRRP affect the treatment group but not the control group. Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Analyzing outcomes based on these different perspectives may potentially have different implications. Prediction of rehospitalization and mortality risks for skilled It is difficult to identify a consistent pattern when it comes to which hospital or patient group experienced the greatest decline. As more data becomes available, it is important to examine the HRRPs long-run effects and implications. Vigorous and timely support from case management and/or social services will be important. WebHF is the leading cause of readmissions in patients age 65 years with high associated societal and economic costs. The Review and Correction period for HRRP is only for discrepancies related to the calculation of the payment reduction and component results. Noting that dual-eligible patients experienced higher readmission rates for all three target conditions (AMI, HR, and PN), the authors argued that HRRP penalties would fall disproportionately on such hospitals, which would affect vulnerable populations. Bazzoli GJ, Chan B, Shortell SM, D'Aunno T. The financial performance of hospitals belonging to health networks and systems. The important findings of this research are that there is evidence that there has been a decline in readmissions across the board, and in some cases with more substantial changes for vulnerable populations. HHS Vulnerability Disclosure, Help After the program was created, readmission rates appeared to decrease nationwide for patients hospitalized with heart failure, acute myocardial infarction, and pneumonia, the three conditions it originally targeted. Each program year, we let hospitals know the exact dates of the Review and Correctionperiod on the QualityNet website. 2023 Jun 1;8(6):545-553. doi: 10.1001/jamacardio.2023.0695. However, a substantial fraction of all hospitalizations are patients returning to the hospital soon after their previous stay. Comorbidity measures for use with administrative data. Rather, its health care system is fragmented and composed of both private and public programs. Table A1 illustrates the DDD approach by comparing changes in readmissions for Medicare AMI and Medicare GI patients. Innovative Programs | Finding Success in Readmissions Reduction Through the Hospital Readmission Reduction Program, the Centers for Medicare & Medicaid Services penalizes hospitals for excess readmissions when compared to expected levels of readmissions. The study uses the Nationwide Readmissions Database (NRD) for 20102014 covering the period before and after the launch of the HRRP. N Engl J Med. We are thus unable to stratify samples based on expansion status. CMS (Centers for Medicare and Medicaid Services) defines a readmission in this context as an admission to a subsection(d) hospital within 30 days of a discharge from the same or another subsection(d) hospital. Subsection(d) hospitals, per the Social Security Act, include short-term inpatient acute care hospitals excluding critical access, psychiatric, rehabilitation, long-term care, children's, and cancer hospitals. Gu Q, Koenig L, Faerberg J, Steinberg CR, Vaz C, Wheatley MP. or WebIt passed AHA-supported legislation requiring Medicare to account for sociodemographic factors starting on Oct. 1, 2018. Updates and Resources on Novel Coronavirus (COVID-19), Institute for Diversity and Health Equity, Rural Health and Critical Access Hospitals, National Uniform Billing Committee (NUBC), AHA Rural Health Care Leadership Conference, Individual Membership Organization Events, AHA Comments to CMS on the Inpatient PPS FY 2020 Proposed Rule, Regulatory Advisory: Inpatient PPS: The Proposed Rule for FY 2020, Inpatient PPS: The Final Rule for FY 2019, AHA to CMS Re: Hospital Inpatient Prospective Payment System Proposed Rule for FY 2019, Inpatient PPS: The Proposed Rule for FY 2019, AHA Special Bulletin: CMS Releases FY 2019 Hospital Inpatient PPS Proposed Rule, The Important Role Hospitals Have in Serving Their Communities, American Organization for Nursing Leadership, Do Not Sell or Share My Personal Information. The number of hospitals in the data ranges from 1715 to 2048 depending on the year. And a close examination of both successful and unsuccessful programs can provide important lessons to accelerate this process. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. The gray columns in Table 4 report DD estimates for conditions that were not targeted by the HRRP. Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation. In addition, the 21st Century Cures Act directs CMS to assess a hospitals performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and full Medicaid benefits beginning in FY 2019. The analysis was based on the principal diagnosis at discharge with certain exclusions: transfers to another acute care hospital, certain readmissions that are unrelated to the prior discharge and certain planned readmissions for procedures related to the AMI measure. 2012. http://collab.fha.org/files/ReadmMeasMaintTechRept_051211.pdf Accessed 15 Nov 2018. Bethesda, MD 20894, Web Policies Background: The Hospital Readmissions Reduction Program (HRRP) was established by the 2010 Patient Protection and Affordable Care Act (ACA) in an effort to reduce excess hospital readmissions, lower health care costs, and improve patient safety and outcomes. Benitez JA, Adams EK, Seiber EE. How much money could hospitals save by avoiding readmissions? Health Serv Res. Another challenge is the magnitude and design of the financial incentives such as what percentage of reimbursement should be used as rewards or penalties; should these percentages remain fixed or change over time; and whether penalties or rewards work better. Hospital Readmission Reduction Program | AHA Hospital Readmissions Reduction Program: Aimed at reducing readmissions within 30 days of discharge (readmission that currently cost Medicare $26 billion per year). The Healthcare Cost and Utilization Project (HCUP), HCUP NRD hospital identification number. We list the following additional caveats in the interpretation of the results. Share sensitive information only on official, secure websites. Hence the DDD estimate may underestimate the effect of the HRRP, in which case the results would be a lower bound on the effect of the HRRP. Chukmaitov AS, Bazzoli GJ, Harless DW, Hurley RE, Devers KJ, Zhao M. Variations in inpatient mortality among hospitals in different system types, 1995 to 2000. For the second type, hospitals were separated into quartiles based on the percentage of low-income patients relative to total patient volume in each hospital for each year. and answer any questions the patient might have. Hospital Readmissions Reduction Program (HRRP) Methodology Heres how you know. For example, in hospital groups based on quartiles of low-income patients, Medicare AMI readmissions decreased the most in the top quartile, whereas HF and PN decreased the most in the lowest quartile. WebEvery woman deserves to thrive. In October 2013, the penalty increased to 2 percent and in October 2014 to 3 percent. We carried out several robustness checks. Although studies have examined the policys overall impacts and differences by hospital types, research is limited on its effects for different types of vulnerable populations. In the majority of cases, hospitalization is necessary and appropriate. Benitez JA, Tipirneni R, Perez V, Davis MM. Rau, J. Hospital readmission - Wikipedia A case in point is the change in Medicare AMI readmissions. access to pharmacies, transportation to follow-up appointments and grocery stores. Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions. You can decide how often to receive updates. More information on past program policies and supplemental data files is available in the CMS HRRP Archives. CMS will continue to look at other potential exclusions from the readmission penalty calculation. 1343, which would address the need for a sociodemographic adjustment. Hence, a hospitals at-risk status is derived for each year. ( Under Trump, Hospitals Face Same Penalties Embraced By Obama. Boccuti C, Casillas, G. Aiming for fewer hospital U-turns: the Medicare hospital readmission reduction program. lock Readmissions in hospitals of the middle quartiles (Groups 2 and 3 in Table 2) decreased too, by 1.7 and 2.0 percentage points, respectively. The decrease among privately insured patients was even smaller for both targeted and non-targeted readmissions. Will It Survive? Sign up to get the latest information about your choice of CMS topics. This observation supports the parallel trend assumption in the DD design which assumes the same trend between the control group and treatment group prior to the policy. Under the aegis of the Patient Protection and Affordable Care Act, the Hospital Readmission Reduction Program (HRRP), enacted in 2010 and implemented beginning in 2013, was part of a broader goal of incentivizing improvement in quality of inpatient care, by linking Medicare reimbursements to a hospital with its relative Carey K, Lin MY. Before 2012 (during the pre-HRRP period), Medicare GI, AMI, HF and PN rates had been decreasing slightly at about the same rate. AHA does not claim ownership of any content, including content incorporated by permission into AHA produced materials, created by any third party and cannot grant permission to use, distribute or otherwise reproduce such third party content. A close examination of the HRRP such as its performance measures, financial incentive structure, and the roll-out process could provide suggestions for adjustment of current P4P programs and the design of future programs. Under this provision, hospitals with relatively high risk-standardized readmission rates (i.e. Readmission The payment reduction is capped at 3 percent (that is, a payment adjustment factor of 0.97). We then divided the patients into four groups by the quartiles of their index scores. Prior to discharge, hospitals are using RNs, case managers and discharge planners to assess high-risk patients, identify patient needs and make sure there is a plan for meeting each need, and provide education and meet other discharge planning needs. Readmissions, observation, and the hospital readmissions reduction program. BMC Health Services Research In 2007, the Medicare Payment Advisory Commission estimated that potentially avoidable readmissions cost Medicare $12 billion every year. Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. HRRP, along with the Hospital Value Based Purchasing (Hospital VBP) and Hospital-Acquired Condition (HAC) Reduction Programs, is a major part of how we add quality measurement, transparency, and improvement to value-based payment in the inpatient care setting. However, ACEP cannot guarantee that the information contained in the FAQs and Pearls is in every respect accurate, complete, or up to date.The FAQs and Pearls are provided "as is" without warranty of any kind, either express or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. Weve included measures of conditions and procedures that make a big difference in the lives of large numbers of people with Medicare. the Medicare hospital readmissions reduction program Additionally, the 21st Century Cures Act requires CMS to assess a hospitals performance relative to other hospitals with a similar proportion of patients who are dually eligible for Medicare and full-benefit Medicaid beginning in FY 2019. An official website of the United States government Heres how you know. Specifically, readmission rates decreased more for high-risk patients than for low-risk patients, and, in the case of Medicare AMI patients, decreased more for Medicare patients from low-income hospitals than for Medicare patients from high-income hospitals. As shown in our study, there are several challenges to evaluate the effectiveness of programs such as the HRRP. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. We use this measure to evaluate HRRPs impact on non-targeted readmissions. Part of Since rates of readmissions for specific care events vary significantly by hospital, Medicare began penalizing hospitals with higher rates of readmissions relative to all other acute-care hospitals under the Hospital Readmissions Reduction Program (HRRP). CMS includes the following six condition/procedure-specific 30-day risk-standardized unplanned readmission measures in the program: For FY 2020, CMS calculates the payment adjustment factor and component results for each hospital based on their performance during the three-year performance period of July 1, 2015 through June 30, 2018. A limitation of NRD is that its hospital identifiers cannot be linked across years or linked to other databases. However, the second gray column in the table shows significant differences in non-target condition readmissions between Medicare patients and private insurance patients 45+ years of age. Correspondence to Future research, using data with State information, should examine the effects of HRRP after taking into account the Medicaid expansion. Unlike the state-level data used in previous studies [7, 14], the hospital identifiers in NRD do not track the same hospital across the years, as mentioned earlier. Patient characteristics and differences in hospital readmission rates. Fredericks S, DaSilva M. An examination of the postdischarge recovery experience of patients who have had heart surgery. Fourth, the available claims data only contained indicators of rehospitalization and mortality within a 60 day window. Commensurate with good patient care, the ED will likely have to work with hospital case managers and discharge planners to determine if there are safe alternative care settings other than a hospital inpatient status. This assumption might not hold true. Privacy If the rates of readmissions to a discharging, or another Inpatient Prospective Payment System (IPPS) hospital were deemed excessive, the hospitals IPPS payments were decreased for all Medicare payments. First, we do not have a way of observing the specific mechanisms that drive the readmission processes at the hospital level. Patient socioeconomic status was measured by four quartiles of the median household income for patients zip code of residence. We rely on secondary administrative data that is limited in terms of describing the clinical details of the hospitalization and the follow-up. Definitions of population vulnerability in the literature generally depend on the quartile of patient income or insurance types such as Medicaid [2, 3, 8]. 2016 Feb 1;54(2):16271. statement and The American College of Emergency Physicians (ACEP) has developed the Reimbursement & Coding FAQs and Pearls for informational purposes only. Comparison of 30-day planned and unplanned readmissions in a tertiary teaching hospital in China. The quartiles were recalculated each year because of NRDs different hospital identifiers over the years. Prediction of rehospitalization and mortality risks for skilled Bookshelf We created the Elixhauser mortality index score for each patient as their comorbidity measures [21,22,23]. These observations support the hypothesis that the HRRP has reduced readmissions in index hospitalizations for Medicare patients. In total, there are ten comparisons between treatment and control groups (e.g., Medicare patients aged 65 and up with AMI vs. Medicare patients aged 65 and up with GI; or Medicare patients aged 65 and up with AMI vs. privately insured patients aged 45 and older with AMI). Or they could have improved patient education and post-discharge experience [39, 40]. The HRRP reduces payments to hospitals with excess Since 2010, Medicare data show that hospitals have prevented more than 565,000 readmissions. The reduction was the largest for upper-middle income patients and high-risk patients. Future studies need to examine and evaluate these efforts. When a hospital reduces its readmission from above to below the national average, this hospital will switch from at-risk to not-at-risk in the following year. Unauthorized use of these marks is strictly prohibited. The readmission measures were calculated for the following five treatment groups among Medicare patients aged 65 and up: each of the three targeted conditions (AMI, HF or PN) separately, the three targeted conditions as a whole, as well as non-target conditions. WebThe Hospital Readmission Reduction Program (HRRP) is a purchasing program focusing on the value provided by a hospital. In the FY 2016 IPPS final rule, CMS finalized adoption of an ECE policy allowing hospitals that experience a significant disaster or other extraordinary circumstance beyond the hospitals control (e.g. From early on, there have been concerns about whether the HRRP can lead to unintended consequences for patients of low socioeconomic status and hospitals serving them. Readmissions, Observation, and the Hospital Readmissions 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, CMS Hospital Readmissions Reduction Program, QualityNet Hospital Readmissions Reduction Program, Help with File Formats Disclaimer. Among Medicare patients, we consistently observe a decline in index readmissions after the HRRP. 2013;35(10):125165. If cream-skimming were to occur, our estimates of the impact of HRRP would be biased, as some of the reductions in readmission rates could be attributed to cream-skimming. and transmitted securely. Hospitals with the largest proportion of low-income patients (Group 4: top quartile in Table 2) had an even larger decrease of 2.6 percentage points, from 19.2 to 16.6%. This DD model is estimated for each of the five types of conditions (AMI, HF, PN, Targeted, Non-Targeted) in order to compare the treatment group with one of the two control groups (Medicare GI or Private Insurance), for a total of ten DD models, each of which is estimated for the entire sample and the 16 quartile-based groups defined previously. We controlled patient location by a six-category urban-rural classification scheme for U.S. counties developed by the National Center for Health Statistics (NCHS). Patient Protection and Affordable Care Act, Centers for Medicare and Medicaid Services, International Classification of Disease, ninth revision, Elective primary total hip arthroplasty and/or total knee arthroplasty (THA/TKA). The Hospital Readmission Reduction Program (HRRP) was created as a way to reduce those costs. Sign up to get the latest information about your choice of CMS topics. The authors are grateful to Dr. Brad Wright, Dr. Joseph Benitez, and Dr. Suzanne Fredericks for their valuable comments and suggestions. CMS includes the following condition or procedure-specific 30-day risk-standardized unplanned readmission measures in the program: CMS calculates the payment reduction and component results for each hospital based on its performance during a rollingperformance period. https:// The AHA continues to urge other improvements to the HRRP, such as using more accurate measures and updating the penalty formula to ensure it provides the right incentive to improve.

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