Readmissions performance and penalty experience of safety-net hospitals under Medicare's Hospital Readmissions Reduction Program.
Readmissions performance and penalty experience of safety-net hospitals under Medicare's Hospital Readmissions Reduction Program.
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DOI：
10.1186/s12913-022-07741-9
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发表时间：
2022-03-15
影响因子：
2.8
通讯作者：
Hanchate AD
中科院分区：
文献类型：
--
作者：
Banerjee S;Paasche-Orlow MK;McCormick D;Lin MY;Hanchate AD
医疗保险和医疗补助服务中心（CMS）于2010年3月制定的医院再入院减少计划（HRRP）对急性心肌梗死（AMI）、心力衰竭和肺炎的再入院率高于预期的急性护理医院实施了减薪处罚。令人关切的是，为大量低收入和无保险病人提供服务的医院（安全网医院）面临更高的再入院率和处罚风险，这往往是由于医院可能无法控制的因素。使用公开报道的数据，我们比较了安全网和非安全网医院的再入院表现和惩罚经验。我们使用了来自医疗保险和医疗补助服务中心（CMS）医院比较计划，CMS最终影响规则和美国医院协会年度调查的2009-2016年全国医院级数据。我们将接受基于收入的公共福利的患者比例最高的四分之一医院确定为安全网医院。使用准实验差异中的差异方法，基于安全网和非安全网医院中HRRP前后30天再入院率（风险调整后）变化的比较，我们估计了与HRRP相关的再入院率变化。我们还比较了安全网和非安全网医院之间的处罚频率。我们的研究队列包括1915家医院，其中479家是安全网医院。在基线（2009年），安全网医院与非安全网医院相比，所有三种情况的再入院率略高：AMI，20.3% vs. 19.8%（p值< 0.001）;心力衰竭，25.2% vs. 24.2%（p值< 0.001）;肺炎，18.7% vs. 18.1%（p值< 0.001）。从2012年开始，所有三个队列的两个医院组的再入院率下降相似。基于差异中差异分析，HRRP与安全网和非安全网医院AMI和心力衰竭再入院率的相似变化相关。对于肺炎队列，我们发现安全网医院的下降幅度更大（0.23%; p < 0.001）。在安全网医院中，再入院处罚的频率较高。在HRRP实施后的所有四年中，安全网医院和非安全网医院中受到惩罚的医院比例分别为72%和59%。我们的研究结果支持了对安全网医院不成比例的更高风险的关注。在线版本包含补充材料，可通过10.1186/s12913-022-07741-9获得。
The Hospital Readmissions Reduction Program (HRRP), established by the Centers for Medicare and Medicaid Services (CMS) in March 2010, introduced payment-reduction penalties on acute care hospitals with higher-than-expected readmission rates for acute myocardial infarction (AMI), heart failure, and pneumonia. There is concern that hospitals serving large numbers of low-income and uninsured patients (safety-net hospitals) are at greater risk of higher readmissions and penalties, often due to factors that are likely outside the hospital’s control. Using publicly reported data, we compared the readmissions performance and penalty experience among safety-net and non-safety-net hospitals. We used nationwide hospital level data for 2009-2016 from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare program, CMS Final Impact Rule, and the American Hospital Association Annual Survey. We identified as safety-net hospitals the top quartile of hospitals in terms of the proportion of patients receiving income-based public benefits. Using a quasi-experimental difference-in-differences approach based on the comparison of pre- vs. post-HRRP changes in (risk-adjusted) 30-day readmission rate in safety-net and non-safety-net hospitals, we estimated the change in readmissions rate associated with HRRP. We also compared the penalty frequency among safety-net and non-safety-net hospitals. Our study cohort included 1915 hospitals, of which 479 were safety-net hospitals. At baseline (2009), safety-net hospitals had a slightly higher readmission rate compared to non-safety net hospitals for all three conditions: AMI, 20.3% vs. 19.8% (p value< 0.001); heart failure, 25.2% vs. 24.2% (p-value< 0.001); pneumonia, 18.7% vs. 18.1% (p-value< 0.001). Beginning in 2012, readmission rates declined similarly in both hospital groups for all three cohorts. Based on difference-in-differences analysis, HRRP was associated with similar change in the readmissions rate in safety-net and non-safety-net hospitals for AMI and heart failure. For the pneumonia cohort, we found a larger reduction (0.23%; p < 0.001) in safety-net hospitals. The frequency of readmissions penalty was higher among safety-net hospitals. The proportion of hospitals penalized during all four post-HRRP years was 72% among safety-net and 59% among non-safety-net hospitals. Our results lend support to the concerns of disproportionately higher risk of performance-based penalty on safety-net hospitals. The online version contains supplementary material available at 10.1186/s12913-022-07741-9.
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影响因子：
39
作者：
Barnett ML;Hsu J;McWilliams JM
通讯作者：
McWilliams JM
影响因子：
9.7
作者：
Gilman, Matlin;Adams, E. Kathleen;Becker, Edmund R.
通讯作者：
Becker, Edmund R.
DOI：
10.1016/j.jcjq.2017.10.002
发表时间：
2018-04-01
影响因子：
2.3
作者：
Fuller, Richard L.;Hughes, John S.;Averill, Richard F.
通讯作者：
Averill, Richard F.
影响因子：
9.8
作者：
Kolstad, Jonathan T.;Kowalski, Amanda E.
通讯作者：
Kowalski, Amanda E.
DOI：
10.1177/1527154411398490
发表时间：
2010-11
期刊：
Policy, politics & nursing practice
影响因子：
--
作者：
McHugh MD;Carthon JM;Kang XL
通讯作者：
Kang XL