Established by the centers for Medicare and Medicaid Services in 2010 to reduce preventable hospitalizations by imposing financial penalties on hospitals with higher than expected 30-daily admission rates.
More than 2000 US hospitals are penalized upward of $200 million for readmissions of Medicare patients within 30 days of discharge.
Initially readmission rates appear to decrease for patients with heart failure, acute myocardial infarction, and pneumonia.
The HRRP define is only inpatient hospitalization and not observation status or emergency department visits as readmissions, which artificially inflate estimates a bit success.
Rates of observation he stays and emergency department visits after inpatient stays have increased, as a result the proportion of patients who return to hospital in 30 days after discharge has not changed.
This program creates strong incentives to treat patients in emergency departments or observation units to avoid readmissions, even if inpatient hospitalization would improve their access to appropriate care.
The HRRP. program does not count for the competing risk of death.
Because death is not factored into readmission rates, hospitals that keep more patients alive and therefore discharge a sicker group of people may be penalized for having higher readmission rates rather than being rewarded for having good outcomes.
Penalties for readmission rates under the HRRP or much larger than penalties for high mortality under the Hospital Value-Based Purchasing program.
Risk adjustment of readmission measure is inadequate, such that fair comparisons among hospitals are not considered.
Risk adjustment models omit social risk factors strong related to readmissions, such as poverty, so hospitals or penalize for serving poor and vulnerable patients.
Under HRRP safety net hospitals are frequently penalized, transf2242ing vital resources.
Studies have indicated that mortality within 30 days following discharge from the hospital for heart failure,the HRRP program resulted in increased mortality.
The increase in mortality was noted to be concentrated among patients who were not readmitted to the hospital, such that the effort to reduce readmissions may adversely affect patients.
Readmission rates appeared to decrease nationwide for patients hospitalized with heart failure, acute myocardial infarction, and pneumonia, the three conditions it originally targeted.
However, the HRRP defines only inpatient hospitalizations — not observation stays or emergency department (ED) visits as readmissions, which has artificially inflated estimates of its success.
Although readmission rates have decreased for targeted conditions, rates of observation stays and ED visits after inpatient stays have increased.
The proportion of patients who return to a hospital within 30 days after discharge has not changed.
The process creates strong incentives to treat patients in EDs or observation units to avoid readmissions, even if inpatient hospitalization would improve their access to appropriate care.
The HRRP also doesn’t include observation stays as index events.
The HRRP metric doesn’t account for the competing risk of death, as a patient who dies can no longer be readmitted.
Penalties for high readmission rates under the HRRP are much larger than penalties for high mortality.
Presently, evidence suggests that reported improvement in risk-adjusted readmission rates that may have been the result of an artificial increase in coexisting conditions rather than improvements in care quality.
Current risk-models omit social risk factors that are strongly related to readmissions, such as poverty, so hospitals tend to be penalized for serving poor and vulnerable patients.
Safety-net hospitals are frequently penalized under the HRRP.
Presently, HRRP hospitals are compared only with other facilities that treat Medicare populations with similar poverty levels, with a significant reduction in penalties for safety-net hospitals
Four independent studies revealed that mortality within 30 days after discharge from a hospitalization for heart failure increased significantly after implementation of the HRRP relative to earlier trends.
This increase was mainly among patients who weren’t readmitted, which raises the possibility that greater use of EDs and observation units by hospitals to reduce readmissions may adversely affect patients who would benefit from higher-level care.
Mortality among patients hospitalized for myocardial infarction has not increased under the HRRP, suggesting that acute conditions may be better suited to the program than chronic conditions such as heart failure.