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.
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.
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.
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.
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: firstname.lastname@example.org.
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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