Abstract 159: Did the Hospital Readmission Reduction Program Result in Delayed Readmissions Just After 30 days?

Abstract

Background: The Hospital Readmission Reduction Program (HRRP) was enacted in March 2010 and imposed financial penalties beginning in October 2012 for hospitals with higher-than-expected 30-day readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia. The HRRP has been associated with reduced readmissions for these conditions, however, evidence has suggested an increase in mortality for heart failure and pneumonia as an unintended consequence of this program. Because of strong hospital responses to the HRRP, we examined whether hospitals postponed readmissions around the 30-day threshold, resulting in a spike in “delayed” readmission just after 30 days. Methods: Hospital admissions for AMI, CHF, and pneumonia were identified between January 2007 and October 2015 using the Medicare Provider Analysis and Review database, containing admissions for all fee-for-service Medicare enrollees. Stroke was studied as a control condition because it was not included in HRRP. Following prior literature, we divided the overall study period into three phases: January 2007 to March 2009 represented the pre-HRRP phase, April 2009 to September 2012 represented the implementation phase, and October 2012 to October 2015 represented the penalty phase. We used an interrupted time-series analysis to examine whether there was an increased probability of readmissions between days 31 to 35 as compared to days 25 to 30. This was implemented using Poisson and Quasi-Poisson models to generate a slope and intercept change model with adjustments for seasonality by condition. We then compared the changes in slopes for AMI, CHF, pneumonia and stroke in the separate phases. Results: A total of 68,020,501 admissions were included in this analysis. For AMI, the slopes for readmissions between days 31 to 35 as compared to days 25 to 30 over time were -0.003, 0.001 and -0.0003 for the three phases, respectively. The change in slope between the pre-HRRP and penalty phase was 0.003 (p=0.31). For pneumonia, the slopes for readmissions between days 31 to 35 as compared to days 25 to 30 over time were 0.002, -0.0004 and 0.001 for the three phases, respectively. The change in slope between the pre-HRRP and penalty phase was -0.001 (p=0.74). For CHF, the slopes for readmissions between days 31 to 35 as compared to days 25 to 30 over time were 0.001, -0.0002 and -0.001 for the three phases, respectively. The change in slope between the pre-HRRP and penalty phase was -0.001 (p=0.29). For stroke, the changes in slope between days 31 to 35 as compared to days 25 to 30 were 0.002, 0.0004 and -0.002 for the three phases, respectively. The change in slope between the pre-HRRP and penalty phase was -0.004 (p=0.11). Conclusions: Using a national sample of Medicare enrollees, we found no association between the start of HRRP and higher likelihood of readmissions for AMI, CHF, or pneumonia just after 30 days.