The Association Between Structural, Performance, and Community Factors and the Likelihood of Receiving a Penalty Under the Hospital Readmissions Reduction Program (Fiscal Year 2013-2019).

Jason N Mose,Neela K Kumar

doi:10.1089/heq.2019.0123

Abstract

Purpose: Little is known about the role of structural, performance, and community factors that impact the likelihood of receiving a penalty under the Hospital Readmission Reduction Program. This study examined the association between structural, performance, and community factors and the likelihood of receiving a penalty as well as investigated the likelihood of hospitals serving vulnerable populations of receiving a penalty.Methods: Centers for Medicare and Medicaid Services and United States Census Bureau data were used in this analysis. Ordered logistic regressions in a cross-sectional analysis were employed to estimate the probability of receiving a high or low penalty in the fiscal year 2013 through 2019.Results: On average, medium-sized, major teaching, and safety-net hospitals had the highest proportion of hospitals with a high penalty. After controlling for performance and community factors, structural factor variables such as safety-net status, rural status, and teaching status either were no longer significant or the likelihood magnitude changed. However, after controlling for performance and community factors, the statistical significance of hospital size variables and geographic location persisted across the years. Length of stay and occupancy rate variables were also statistically significant across the 7 years under review.Conclusion: Taken together, structural, performance, and community factors are important in explaining variation in the likelihood of receiving a penalty. There is no evidence that safety-net, rural, and public hospitals are more likely to receive a penalty. The results also suggest that there is room for providers to reduce avoidable readmissions and policymakers to mitigate unintended consequences.

Highlights

The Hospital Readmission Reduction Program (HRRP)is a Centers of Medicare and Medicaid (CMS) incentive program authorized under the Affordable Care Act
HRRP was created as a response to concerns regarding adverse patient outcomes, high cost associated with readmission, and lack of incentives for hospitals to tackle the burden of readmissions.[1,2]
This finding decreased in magnitude and significance in later years, except in 2019, when a safety-net hospital was associated with a 4.6% ( p < 0.001) point decrease in the predicted probability of receiving a high penalty

Summary

Introduction

Is a Centers of Medicare and Medicaid (CMS) incentive program authorized under the Affordable Care Act. The objective of the program is to reduce avoidable readmission among Medicare fee-for-service beneficiaries by penalizing hospitals that have higher than expected readmissions. HRRP was created as a response to concerns regarding adverse patient outcomes, high cost associated with readmission, and lack of incentives for hospitals to tackle the burden of readmissions.[1,2] Previous studies and advisories to Congress recognized excess readmissions as a signal for suboptimal inpatient care, lack of care coordination, and lack of appropriate.

Methods

Results

Discussion

Conclusion