Michelle Hou

Michelle Hou is a statistician working with MVC.

Chad Ellimoottil

Dr. Chad Ellimoottil is a research fellow working with MVC.

Many hospital administrators and clinicians are under increasing pressure to reduce readmissions. At least part of this pressure comes from Medicare’s Hospital Readmissions Reduction Program (HRRP). This program imposes a penalty on hospitals that have an excess number of readmissions. All hospital readmissions as well as readmissions for specific conditions (e.g., congestive heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease, or joint replacement) are measured by Medicare. We scoured the literature and performed our own analysis of Michigan Medicare data to bring you 10 surprising facts about the HRRP program.

  1. In 2015, almost 80% of hospitals received a penalty under HRRP. While the average hospital penalty was less than a percent of total income, Medicare collected more than $400 million in penalties.
  2. In 2015, ten percent of hospitals accounted for nearly 50 percent of the penalties. Because socioeconomic factors play such a big role in readmissions, it is understandable that the impact of the penalties are concentrated.
  3. A readmission from three years ago may impact your hospital’s score today. Because the program incorporates three years of data in its calculation of condition-specific readmission rates, some patients may impact readmission performance for years to come.
  4. While readmission measures may be “condition-specific”, readmissions from “all-causes” count against your hospital. For example, if the patient is admitted for joint replacement, and then is readmitted for stomach pain, the readmission counts against the hospital.
  5. Small hospitals may not be unfairly penalized for a few extra readmissions. There are sophisticated statistical adjustments made to account for hospitals that may have a small number of yearly admissions.
  6. Readmissions caused by patients who leave “against medical advice” do not count against the hospital. Because providers were not given the full opportunity to provide care and discharge planning for these patients, they are excluded from the readmission measure.
  7. Over 50 different comorbidities are considered to make sure hospitals are compared on an equal playing field. In other words, Medicare’s readmission measures are “risk-adjusted”.
  8. About 21% readmissions in the state of Michigan occur at hospitals other than one where the patient was initially hospitalized. These findings were based on an internal MVC analysis of readmissions and speak to the importance of using claims-based data to track readmissions.
  9. Approximately 85% of patients who are readmitted within 30-days come in through the emergency room.
  10.  About 8% of readmissions are considered “planned”. Planned readmissions are not counted against the hospital. They can occur for planned procedures or diagnoses that are not associated with an acute condition.

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