Greater Reductions in Readmission Rates Achieved by Urban Hospitals Participating in the Medicare Shared Savings Program.

Abstract

Accountable Care Organizations in the Medicare Shared Savings Program (MSSP) have financial incentives to reduce the cost and improve the quality of care delivered to Medicare beneficiaries that they serve. However, previous research about the impact of the MSSP on readmissions is limited and mixed. To examine the association between hospital participation in the MSSP during the 2012-2013 period and reductions in 30-day risk-standardized readmission rates for Medicare patients initially admitted for acute myocardial infarction, heart failure (HF), pneumonia, or any cause. Difference-in-differences estimation to compare the change in readmission rates for hospitals participating in the MSSP with that of other hospitals. Acute care hospitals that either participated in the MSSP or did not participate in any of Medicare Accountable Care Organization programs (for acute myocardial infarction, n=1631; for HF, n=1889; for pneumonia, n=1896; for any cause, n=2067). Compared with nonparticipating hospitals, MSSP-participating hospitals showed greater reductions in readmission rates for Medicare patients originally admitted for HF by 0.47 percentage points [95% confidence interval (CI), -0.76 to -0.17] and for pneumonia by 0.26 percentage points (95% CI, -0.49 to -0.03). MSSP-participating hospitals also showed more reductions in hospital-wide all-cause readmission by 0.10 percentage points (95% CI, -0.20 to 0.01), relative to nonparticipating hospitals during the first year of MSSP. MSSP-participating hospitals showed slightly greater reductions in readmissions during postimplementation years for Medicare patients initially admitted for HF or pneumonia, compared with other hospitals.