Affiliation:
1. Department of Systems, Populations and Leadership University of Michigan School of Nursing Ann Arbor Michigan USA
2. Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor Michigan USA
3. Department of Medicine, Division of Geriatric and Palliative Medicine University of Michigan Ann Arbor Michigan USA
4. Geriatric Research Education and Clinical Care Center (GRECC) VA Medical Center Ann Arbor Michigan USA
5. Division of Geriatric and Palliative Medicine, Department of Internal Medicine University of Michigan Ann Arbor Michigan USA
6. Department of Health Policy and Management University of Michigan School of Public Health Ann Arbor Michigan USA
7. Veterans Affairs Center for Clinical Management and Research (CCMR) VA Medical Center Ann Arbor Michigan USA
8. VA Center for Clinical Management Research Ann Arbor VA Healthcare System Ann Arbor Michigan USA
Abstract
AbstractObjectiveTo assess whether Medicare's Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall‐related injuries (FRIs).Data Sources and Study SettingSecondary data from Medicare were used.Study DesignUsing 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 CollectionNot applicable.Principal FindingsWe 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).ConclusionsHRRP 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.
Funder
Centers for Disease Control and Prevention