Hospital Responses to Medicare Readmission Penalties

医院对医疗保险再入院处罚的反应

• 批准号: 9638616
• 负责人: TERESA M WATERS
• 金额: $ 6.79万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9638616
• 关键词: Hospital; Responses; Medicare; Readmission; Penalties

 DESCRIPTION (provided by applicant): Early hospital readmissions (readmission within 30 days) are common, costly and potentially preventable. Between 18 and 20 % of Medicare beneficiaries discharged from a hospital in 2003 and 2004 were readmitted within 30 days, costing the Medicare program an estimated $17 billion annually. A variety of interventions to reduce readmission have been tested, with mixed results. In FY2013, CMS began assessing financial penalties on hospitals with unplanned readmission rates for congestive heart failure (CHF), acute myocardial infarction (AMI) and pneumonia (PN) that exceeded rates expected for their patient population under the Hospital Readmissions Reduction Program (HRRP). Almost half of all U.S. hospitals face penalties under the program. The novelty of financial penalties in hospital reimbursement, along with their size and scope, make investigation of HRRP's impact a critical priority. Thus, we propose the following questions: Q1: Which hospitals are getting penalties and how are their readmission rates changing over time? Using descriptive, stratified analyses, we will examine penalties and readmission rates over time for various types of hospitals, including those with high, low and no penalty, those serving large low-income and/or minority populations, safety net and financially troubled hospitals. Descriptive analyses will provide context for subsequent analyses and timely, clear information about whether and how the policy should be changed. Q2: What is the impact of HRRP on Medicare readmission rates targeted by the program? Using hierarchical generalized linear models where patient, hospital and market characteristics influence condition- specific readmission rates we will examine readmissions before and after the policy change. Our primary focus will be CHF, AMI and PN, with a secondary focus on new conditions targeted in FY 2015: chronic obstructive pulmonary disease, coronary artery bypass graft surgery, and percutaneous coronary interventions. Q3: Do we observe any spillover effects of HRRP on other readmission rates? If hospitals find it unethical, impractical, or unprofitable to treat Medicare CHF/AMI/PN patients differently from other patients, we may see spillover effects. We will look for these among readmissions for similar conditions to those covered by HRRP and among non-Medicare readmissions for the same conditions. For comparison, we will also look at readmissions for dementia and back pain, two clinically unrelated conditions not covered by HRRP. Using 2010-2014 Health Care Utilization Project (HCUP) State Inpatient Databases from 9 states, publicly reported penalties, American Hospital Association Annual Survey of Hospitals data, Medicare hospital data, Area Resource File and Census data, we will address study questions. We use HCUP data since they are released earlier than Medicare claims and include non-Medicare patients. Our combined descriptive and multivariate approach facilitates timely policy-oriented publications (Q1) and rigorous assessment of HRRP's effect on targeted and non-targeted readmissions for Medicare and non-Medicare populations (Q2 and Q3).

 描述（由申请人提供）：过早再入院（30 天内再入院）很常见，费用高昂，而且是可以预防的。 2003 年和 2004 年出院的医疗保险受益人中有 18% 到 20% 在 30 天内重新入院，每年估计医疗保险计划花费 170 亿美元。已经测试了各种减少再入院的干预措施，但结果好坏参半。 2013 财年，CMS 开始对充血性心力衰竭 (CHF)、急性心肌梗塞 (AMI) 和肺炎 (PN) 的计划外再入院率超过医院再入院减少计划 (HRRP) 下患者群体预期再入院率的医院进行经济处罚。几乎一半的美国医院都面临该计划的处罚。医院报销中经济处罚的新颖性及其规模和范围使得 HRRP 影响的调查成为重中之重。因此，我们提出以下问题： Q1：哪些医院受到处罚？它们的再入院率随时间变化如何？通过描述性分层分析，我们将研究不同类型医院随着时间的推移的处罚和再入院率，包括高处罚、低处罚和无处罚的医院、为大量低收入和/或少数族裔人口服务的医院、安全网医院和陷入财务困境的医院。描述性分析将为后续分析提供背景，并提供关于是否以及如何改变政策的及时、清晰的信息。问题 2： HRRP 对计划目标医疗保险再入院率有何影响？使用分层广义线性模型，其中患者、医院和市场特征影响特定情况的再入院率，我们将检查政策变化之前和之后的再入院率。我们的主要关注点是 CHF、AMI 和 PN，其次关注 2015 财年的新疾病：慢性阻塞性肺疾病、冠状动脉搭桥手术和经皮冠状动脉介入治疗。问题 3：我们是否观察到 HRRP 对其他再入院率有任何溢出效应？如果医院发现以不同于其他患者的方式治疗 Medicare CHF/AMI/PN 患者不道德、不切实际或无利可图，我们可能会看到溢出效应。我们将在与 HRRP 所涵盖的情况相似的再入院者中以及在相同情况下的非医疗保险再入院者中寻找这些信息。为了进行比较，我们还将研究痴呆症和背痛的再入院情况，这两种临床上不相关的疾病未纳入 HRRP 范围。 我们将使用来自 9 个州的 2010-2014 年医疗保健利用项目 (HCUP) 州住院患者数据库、公开报告的处罚、美国医院协会医院年度调查数据、医疗保险医院数据、地区资源文件和人口普查数据来解决研究问题。我们使用 HCUP 数据，因为它们的发布时间早于 Medicare 索赔，并且包括非 Medicare 患者。我们结合描述性和多变量方法有助于及时发布以政策为导向的出版物（第一季度），并严格评估 HRRP 对医疗保险和非医疗保险人群的定向和非定向再入院的影响（第二季度和第三季度）。