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Impact of the Hospital Readmission Reduction Program on Surgical Readmissions Among Medicare Beneficiaries
Andrew M Ibrahim, Hari Nathan, Jyothi Thumma, Justin B. Dimick
University of Michigan, ANN ARBOR, MI

Objective:The Hospital Readmission Reduction Program, established under the Affordable Care Act in March of 2010, placed financial penalties on hospitals with higher-than-expected rates of readmission beginning in 2012 for targeted medical conditions. Little is known about the impact of this program on this both future targeted and non-targeted surgical procedures. Methods:A retrospective review Medicare 5,122,240 beneficiaries who underwent future targeted procedures (total hip replacement, total knee replacements) or non-targeted procedures (colectomy, lung resection, abdominal aortic aneurysm repair, coronary artery bypass graft, aortic valve replacement, mitral valve repair) using an interrupted time-series model to assess the rates of readmission before the Hospital Readmission Reduction Program was announced (2008-2010), while the program was being implemented (2010-2012) and after penalties were initiated (2012-2014).Results:From 2008 to 2014 rates of readmission declined for both target conditions(6.8%->4.5%; p>0.001) and non-target conditions(17.1%->13.4%; p>0.001). The rate of reduction was most prominent after announcement of the program between 2010-2012 for both targeted and non-targeted conditions (Figure 1.)During the same time period, mean hospital length of stay decreased; non-targeted conditions (10.4->8.4 days; p>0.001) and targeted conditions (3.6->2.8 days; p>0.001).Conclusions:Trends in readmissions after inpatient surgery are consistent with hospitals responding to financial incentives announced in the Hospital Readmission Reduction Program. There appears to be both an anticipatory effect (target procedures reducing readmission before payments implemented) as well as a spillover effect (non-targeted procedures also reducing readmissions.)

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