The Hospital Readmissions Reduction Program and Observation Hospitalizations.
The Hospital Readmissions Reduction Program and Observation Hospitalizations.
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DOI：
10.12788/jhm.3634
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发表时间：
2021-07-01
影响因子：
2.6
通讯作者：
Kind, Amy Jh
中科院分区：
文献类型：
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作者：
Sheehy, Ann M;Kaiksow, Farah;Kind, Amy Jh
医疗保险和医疗补助服务中心（CMS）医院再入院减少计划（HRRP）对在目标条件下住院30天内有过多住院再住院的医院进行处罚。观察性住院的频率正在增加，临床上可能类似于住院患者住院，但HRRP排除了指数和30天再住院计数的观察。使用100%的2014年医疗保险按服务收费索赔和CMS的30天再住院方法，我们模拟了观察住院如何影响HRRP指标时，计数为指数（分母）和30天（分子）再住院。在3，806，772例因HRRP疾病而住院的指标中，418，923例（11%）为观察期; 18%（155，553/876，033）例再住院，由于观察住院作为指标，HRRP无法看到（34%; 63，740/188，430）、30天结局（53%; 100，343/188，430）或两者（13%; 24，347/188，430）。通过忽略观察住院作为指标和30天事件，错过了近五分之一的HRRP再住院。政策制定者可能会认为这是一个机会，以解决两级观察和住院医院计费区别的广泛挑战。
The Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP) penalizes hospitals having excess inpatient rehospitalizations within 30 days of index inpatient stays for targeted conditions. Observation hospitalizations are increasing in frequency and may clinically resemble inpatient hospitalizations, yet HRRP excludes observation in index and 30-day rehospitalization counts. Using 100% 2014 Medicare fee-for-service claims and CMS's 30-day rehospitalization methodology, we modeled how observation hospitalizations impact HRRP metrics when counted as index (denominator) and 30-day (numerator) rehospitalizations. Of 3,806,772 index hospitalizations for HRRP conditions, 418,923 (11%) were observation; 18% (155,553/876,033) of rehospitalizations were invisible to HRRP due to observation hospitalization as index (34%; 63,740/188,430), 30-day outcome (53%; 100,343/188,430), or both (13%; 24,347/188,430). By ignoring observation hospitalizations as index and 30-day events, nearly one of five HRRP rehospitalizations is missed. Policymakers might consider this an opportunity to address broad challenges of the two-tiered observation and inpatient hospital billing distinction.