American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act

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Temporal changes in the readmission rates for patient groups and conditions that were not directly under the purview of the Hospital Readmissions Reduction Program (HRRP) can help assess whether efforts to lower readmissions extended beyond targeted patients and conditions.

Methods

Using the Nationwide Readmissions Database (2010-2015), we assessed trends in all-cause readmission rates for 1 of the 3 HRRP conditions (acute myocardial infarction, heart failure, pneumonia) or conditions not targeted by the HRRP in age-insurance groups defined by age group (≥65 years or <65 years) and payer (Medicare, Medicaid, or private insurance).

Results

In the group aged ≥65 years, readmission rates for those covered by Medicare, Medicaid, and private insurance decreased annually for acute myocardial infarction (risk-adjusted odds ratio [OR; 95% confidence interval] among Medicare patients, 0.94 [0.94-0.95], among Medicaid patients, 0.93 [0.90-0.97], and among patients with private-insurance, 0.95 [0.93-0.97]); heart failure (ORs, 0.96 [0.96-0.97], 0.96 [0.94-0.98], and 0.97 [0.96-0.99], for the 3 payers, respectively), and pneumonia (ORs, 0.96 [0.96-0.97), 0.94 [0.92-0.96], and 0.96 [0.95-0.97], respectively). Readmission rates also decreased in the group aged <65 years for acute myocardial infarction (ORs: Medicare 0.97 [0.96-0.98], Medicaid 0.94 [0.92-0.95], and private insurance 0.93 [0.92-0.94]), heart failure (ORs, 0.98 [0.97-0.98]: 0.96 [0.96-0.97], and 0.97 [0.95-0.98], for the 3 payers, respectively), and pneumonia (ORs, 0.98 [0.97-0.99], 0.98 [0.97-0.99], and 0.98 [0.97-1.00], respectively). Further, readmission rates decreased significantly for non-target conditions.

Conclusions

There appears to be a systematic improvement in readmission rates for patient groups beyond the population of fee-for-service, older, Medicare beneficiaries included in the HRRP.

Background

The Hospital Readmissions Reduction Program (HRRP) has been associated with substantial reductions in readmission within 30 days of discharge among fee-for-service Medicare beneficiaries aged ≥65 years who are hospitalized with acute myocardial infarction, heart failure, or pneumonia—the target population for this program.1,2 There have been suggestions that hospitals might have pursued reductions in readmissions through efforts mainly directed toward Medicare beneficiaries aged ≥65 years without pursuing systematic improvements in the care of patients.3 Other reports have suggested an inconsistent cross-sectional association between hospital-level readmission rates for Medicare beneficiaries for conditions covered under the HRRP compared with other patient groups.4, 5 However, an assessment of the temporal association between the HRRP’s introduction and changes in readmissions for patient groups other than the Medicare beneficiaries targeted in the program is essential to assess how rates of readmission have evolved in an era with emphasis on readmission reduction for patients who were not directly being targeted for quality improvement nationally.

Accordingly, we used the Healthcare Cost and Utilization Project’s Nationwide Readmissions Database (NRD), a nationally representative all-payer database, for 2010-2015 to assess temporal trends in 30-day readmission rates for the 3 HRRP target conditions (acute myocardial infarction, heart failure, and pneumonia) and other conditions not targeted by the HRRP, across age-insurance groups.

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-Suveen Angraal, MD, Rohan Khera, MD, Shengfan Zhou, MS, Yongfei Wang, MS, Zhenqiu Lin, PhD, Kumar Dharmarajan, MD, MBA, Nihar R. Desai, MD, MPH, Susannah M. Bernheim, MD, MHS, Elizabeth E. Drye, MD, SM, Khurram Nasir, MD, MPH, Leora I. Horwitz, MD, MHS, Harlan M. Krumholz, MD, SM

This article originally appeared in the November issue of The American Journal of Medicine.

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