Medicare's Hospital Readmission Reduction Program reduced fall-related health care use: An unexpected benefit?

Objective: To assess whether Medicare's Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall-related injuries (FRIs).

Data sources and study setting: Secondary data from Medicare were used.

Study design: Using an event study design, among older (≥65) Medicare fee-for-service beneficiaries, we assessed changes in 30- and 90-day FRI readmissions before and after HRRP's announcement (April 2010) and implementation (October 2012) for conditions targeted by the HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) versus "non-targeted" (gastrointestinal) conditions. We tested for modification by hospitals with "high-risk" before HRRP and accounted for potential upcoding. We also explored changes in 30-day FRI readmissions involving emergency department (ED) or outpatient care, care processes (length of stay, discharge destination, and primary care visit), and patient selection (age and comorbidities).

Data collection: Not applicable.

Principal findings: We identified 1.5 million (522,596 pre-HRRP, 514,844 announcement, and 474,029 implementation period) index discharges. After its announcement, HRRP was associated with 12%-20% reductions in 30- and 90-day FRI readmissions for patients with CHF (-0.42 percentage points [ppt], p = 0.02; -1.53 ppt, p < 0.001) and AMI (-0.35, p = 0.047; -0.97, p = 0.001). Two years after implementation, HRRP was associated with reductions in 90-day FRI readmission for AMI (-1.27 ppt, p = 0.01) and CHF (-0.98 ppt, p = 0.02) patients. Results were similar for hospitals at higher versus lower baseline risk of FRI readmission. After HRRP's announcement, decreases were observed in home health (AMI: -2.43 ppt, p < 0.001; CHF: -8.83 ppt, p < 0.001; pneumonia: -1.97 ppt, p < 0.001) and skilled nursing facility referrals (AMI: -5.95 ppt, p < 0.001; CHF: -3.19 ppt, p < 0.001; pneumonia: -10.27 ppt, p < 0.001).

Conclusions: HRRP was associated with reductions in FRIs, primarily for HF and pneumonia patients. These decreases may reflect improvements in transitional care including changes in post-acute referral patterns that benefit patients at risk for falls.

 

Comments:

This abstract summarizes a research study that aims to assess whether Medicare's Hospital Readmissions Reduction Program (HRRP) has had an impact on the occurrence of severe fall-related injuries (FRIs) among older Medicare fee-for-service beneficiaries. The study focuses on the period before and after the announcement (April 2010) and implementation (October 2012) of HRRP, comparing conditions targeted by HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) with "non-targeted" conditions (gastrointestinal).

The researchers used an event study design and analyzed data from 1.5 million index discharges. The findings suggest that after the announcement of HRRP, there were 12%-20% reductions in 30- and 90-day FRI readmissions for patients with CHF and AMI. Two years after HRRP implementation, reductions in 90-day FRI readmissions were observed for AMI and CHF patients. Similar results were found for hospitals with higher and lower baseline risks of FRI readmission.

The study also explored changes in specific aspects, such as emergency department or outpatient care involvement, care processes (length of stay, discharge destination, and primary care visits), and patient selection based on age and comorbidities. Additionally, the researchers noted decreases in home health and skilled nursing facility referrals after HRRP's announcement.

The conclusions suggest that HRRP was associated with reductions in FRIs, particularly for CHF and pneumonia patients. The observed decreases may be attributed to improvements in transitional care, including changes in post-acute referral patterns that benefit patients at risk for falls. The findings contribute to understanding the broader impacts of healthcare policies on patient outcomes and care processes.