Abstract 1: Readmission Rates Across All Insurance Types After Passage of the Hospital Readmissions Reduction Program: A Nationwide Analysis

Abstract

Introduction: Since implementation of the Hospital Readmission Reduction Program (HRRP), readmission rates have declined among Medicare patients hospitalized with conditions targeted by the policy - myocardial infarction, heart failure, and pneumonia. It is unknown if similar reductions occurred for other insurance types (Medicaid, private). Methods: We conducted a difference-in-difference analysis using the Nationwide Readmission Database. First, we calculated quarterly readmission rates for each insurance type and target condition from 2010 to 2014. Second, we compared how quarterly readmission rates for target conditions changed before (2010-2012) and after HRRP implementation (2012-2014), using changes in readmissions for non-target conditions as controls. The analysis included 3,737,589 patients with target conditions and 31,096,617 patients with non-target conditions. Results: Following HRRP implementation, readmission rates declined for both Medicare and Medicaid patients. Medicaid readmissions for patients with target conditions declined at a significantly greater rate compared to non-target conditions, both in aggregate (change in slope between pre- and post-HRRP periods, -0.044%/quarter [95% CI -0.061; -0.027]), and for each condition: acute myocardial infarction (-0.098 [-0.132; -0.064]), heart failure (-0.030 [-0.055; -0.005]) and pneumonia (-0.079 [-0.107;-0.051]). Composite Medicaid readmission rates, however, remained higher than Medicare. Privately-insured patients had the lowest aggregate readmission rates throughout the study period, with no additional decline after HRRP implementation. Conclusions: The HRRP was associated with reductions in readmissions that extended to the Medicaid population. These findings may reflect the effect of system-wide efforts to reduce readmissions in response to the policy. Medicaid readmission rates, however, remained greater compared to other insurers, and should be considered a focus for future readmission reduction initiatives. Figure. Change in Readmission Rates for All Target Conditions, Across Insurance Types Points represent quarterly risk-adjusted readmission rates. Solid lines were generated from these points through a piecewise linear model. The dashed line separates the pre- and post-HRRP periods.