K. R. Chhabra1,2,4, A. M. Ibrahim2,3,4, J. R. Thumma2, J. B. Dimick2,3,4 1Brigham And Women’s Hospital,Department Of Surgery,Boston, MA, USA 2University Of Michigan,Center For Healthcare Outcomes And Policy,Ann Arbor, MI, USA 3University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 4University Of Michigan,IHPI Clinician Scholars Program,Ann Arbor, MI, USA
Introduction:
The Hospital Readmissions Reduction Program, announced in 2010 to penalize excess readmissions for patients with select medical diagnoses, was expanded in 2013 to include targeted surgical diagnoses beginning with hip and knee replacements. The impact of these procedure-specific penalties for targeted procedures is not well understood.
Methods:
A retrospective review of 2,627,974 patients who underwent total hip replacement or total knee replacement from 100% fee-for-service Medicare claims. We used an interrupted time series model to assess hospital rates of readmission before the Hospital Readmissions Reduction Program was announced (2008-2010), during implementation for medical conditions (2010-2013) and after specific hip/knee replacement penalties were announced (2013-2016). We also assessed trends in length of stay and the use of observation status.
Results:
From 2008 to 2016, readmission rates declined for total hip replacement (7.8%–5.6%) and total knee replacement (7.0%–5.2%). Readmission rates were decreasing in 2008-2010, but the decline accelerated after the announcement of Hospital Readmissions Reduction Program in 2010 (slope change ?0.06 to -0.09). Readmissions continued to decrease after targeted surgical procedures were announced in 2013, but at a slower rate (slope change -0.09 to -0.05). During the same time period, mean length of stay decreased (3.6 d–2.4 d for total hip replacement, 3.6–2.5 d for total knee replacement). There was no change in the trend of observation status use before and after the Hospital Readmission Reduction Program.
Conclusions:
The major reduction in surgical readmissions rates occurred after the initial announcement of the Hospital Readmission Reduction Program, rather than after penalties for specific surgical procedures were announced. These findings suggest that the initial policy (for medical conditions) had a broad spillover effect, leading to improvements in surgical readmission rates as well.
