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National Trends in Readmission Following Inpatient Surgery in the Hospital Readmissions Reduction Program Era

Mehtsun, Winta T. MD, MPH*,‡; Papanicolas, Irene PhD*,¶; Zheng, Jie PhD*; Orav, E. John PhD†,§; Lillemoe, Keith D. MD; Jha, Ashish K. MD, MPH*,||

doi: 10.1097/SLA.0000000000002350

Objective: The aim of this study was to investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a “spillover” effect on surgical conditions.

Summary Background Data: During the past decade, there have been multiple national efforts to improve surgical care. Readmission rates are a key metric for assessing surgical quality. Whether surgical readmission rates have declined, and whether the Hospital Readmissions Reduction Program has had an influence is unclear.

Methods: Using national Medicare data, we identified patients undergoing a range of procedures during the past decade. We examined whether certain procedures that would be targeted by the HRRP had a differential change in readmissions compared to other procedures. We used an interrupted time-series model to examine readmission trends in three time periods: pre-ACA, HRRP implementation, and HRRP penalty.

Results: Between 2005 and 2014, 17,423,106 patients underwent the procedures of interest; risk-adjusted rates of readmission across the 8 procedures declined from 12.2% to 8.6%. Pre-ACA rates of readmission were decreasing [−0.060% per quarter (−0.072%, −0.048%), P < 0.001]. During the HRRP implementation period, the rate of decline of readmissions increased [−0.129% (−0.142%, −0.116%), P < 0.001] and continued declining at a similar rate during the penalty period [−0.118% (−0.131%, −0.105%), P < 0.001]. Largest declines in surgical readmissions were seen among the nontargeted procedures. The hospitals with the greatest reductions in medical readmissions also had the greatest drop in surgical readmissions.

Conclusions: Surgical readmission rates have fallen during the past decade and rates of decline have increased during the HRRP period.

*Department of Health Policy and Management

Department of Biostatistics, Harvard T.H. Chan School of Public Health

Department of Surgery, Massachusetts General Hospital

§Department of Medicine, Brigham and Women's Hospital

||Department of General Internal Medicine, VA Boston Healthcare System all in Boston, MA

LSE Health, Department of Social Policy, The London School of Economics & Political Science, London, UK.

Reprints: Winta T. Mehtsun, MD, MPH, 42 Church St., Cambridge, MA 02138. E-mail:

Reprints will not be available from the author.

The authors report no conflicts of interest.

Funding Source: R25CA92203 of the National Cancer Institute.

WTM received funding for this work from R25CA92203 of the National Cancer Institute.

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