Abstract
BackgroundThe Hospital Readmissions Reduction Program (HRRP) was introduced to reduce readmission rates among Medicare beneficiaries, however little is known about readmissions and costs for HRRP-targeted conditions in younger populations. The primary objective of this study was to examine readmission trends and costs for targeted conditions during policy implementation among younger and older adults in the U.S.MethodsWe analyzed the Nationwide Readmission Database from January 2010 to September 2015 in younger (18–64 years) and older (≥65 years) patients with acute myocardial infarction (AMI), heart failure (HF), pneumonia, and acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Pre- and post-HRRP periods were defined based on implementation of the policy for each condition. Readmission rates were evaluated using an interrupted time series with difference-in-difference analyses and hospital cost differences between early and late readmissions (≤30 vs. > 30 days) were evaluated using generalized linear models.ResultsOverall, this study included 16,884,612 hospitalizations with 3,337,266 readmissions among all age groups and 5,977,177 hospitalizations with 1,104,940 readmissions in those aged 18–64 years. Readmission rates decreased in all conditions. In the HRRP announcement period, readmissions declined significantly for those aged 40–64 years for AMI (p < 0.0001) and HF (p = 0.003). Readmissions decreased significantly in the post-HRRP period for those aged 40–64 years at a slower rate for AMI (p = 0.003) and HF (p = 0.05). Readmission rates among younger patients (18–64 years) varied within all four targeted conditions in HRRP announcement and post-HRRP periods. Adjusted models showed a significantly higher readmission cost in those readmitted within 30 days among younger and older populations for AMI (p < 0.0001), HF (p < 0.0001), pneumonia (p < 0.0001), and AECOPD (p < 0.0001).ConclusionReadmissions for targeted conditions decreased in the U.S. during the enactment of the HRRP policy and younger age groups (< 65 years) not targeted by the policy saw a mixed effect. Healthcare expenditures in younger and older populations were significantly higher for early readmissions with all targeted conditions. Further research is necessary evaluating total healthcare utilization including emergency department visits, observation units, and hospital readmissions in order to better understand the extent of the HRRP on U.S. healthcare.
Highlights
The Hospital Readmissions Reduction Program (HRRP) was introduced to reduce readmission rates among Medicare beneficiaries, little is known about readmissions and costs for HRRP-targeted conditions in younger populations
Readmission trends among targeted conditions prior to and after HRRP implementation Acute myocardial infarction
With total expenditures as the outcome, adjusted models showed a significantly higher readmission cost in those readmitted within 30 days for acute myocardial infarction (AMI) ($15,981.08, 95% CI [$13, 712.21–$18,444.93], p < 0.0001), heart failure (HF) ($16,461.36, 95% CI [$15,275.93–$17,711.23], p < 0.0001), pneumonia ($12, 622.84, 95% CI [$11,880.55–$13,385.01], p < 0.0001), and acute exacerbations of chronic obstructive pulmonary disease (AECOPD) ($10,728.7, 95% CI [$10,074.03–$11,410.21], p < 0.0001) (Table 5)
Summary
The Hospital Readmissions Reduction Program (HRRP) was introduced to reduce readmission rates among Medicare beneficiaries, little is known about readmissions and costs for HRRP-targeted conditions in younger populations. The primary objective of this study was to examine readmission trends and costs for targeted conditions during policy implementation among younger and older adults in the U.S. Reducing avoidable and costly re-hospitalizations within 30 days of discharge among Medicare beneficiaries in the United States has become a consensus from governments and researchers [1]. The Hospital Readmissions Reduction Program (HRRP) was initially introduced as part of the Patient Protection and Affordable Care Act (PPACA) in 2010 with the goal of creating financial inpneumonia, and AECOPD prior to and after implementation of the policy among younger and older populations in the United States and (ii) evaluate the hospital cost differences between early and late readmission events. The penalties associated with the HRRP increased to 3% of all Medicare payments for fiscal year (FY) 2015, and > 2500 hospitals will face HRRP penalties for FY 2020 [3]
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