Profiling Improvement under the Hospital Readmissions Reduction Program

项目总结/摘要 根据ACA的医院再入院减少计划（HRRP），医疗保险中心 医疗补助服务（CMS）对超过30天风险的医院实施经济处罚- 调整了目标条件的再入院率。尽管初步的成功， HRRP，一些观察员对处罚规则表示严重关切， 建议对项目进行修改一个特别的批评涉及HRRP的影响 安全网医院（SNH）为相对较高比例的低收入患者提供服务， 自我效能低，再入院概率高的人如果SNH被处罚 部分原因是由于他们无法控制的社会经济因素造成的再入院风险， 可能适合这些设施。ACA规定了罚款公式和上限， 实施时间表和三个初步目标条件。这个基金会是 通过成为法律; CMS被授予权力，以扩大该计划“，因为确定 适当。”迄今为止，对《人力资源方案》的评估主要审查了以下方面的总体变化： 再入院或已确定与处罚相关的医院特征。然而，没有研究 重点关注该计划下的个别医院改进或类型， 医院的特点，实现了更大的减少再入院。根据定义， 再入院率最高的医院受到的处罚也最重。然而 接受最大的惩罚并不等于取得最大的进步， 受到更高处罚的医院的特征不一定与这些相关 最大程度减少再入院率的医院使用描述性和统计性 技术，该项目衡量个别医院和医院的改善率 集水区，并确定与较大和较小的 改善30天再入院率。了解哪些类型的医院， 人口在HRRP下取得了最大的成功，而在HRRP未能取得成功的地方， 减少再入院将为CMS提供有价值的新信息，因为它完善了该计划。

PROJECT SUMMARY/ABSTRACT Under the ACA’s Hospital Readmissions Reduction Program (HRRP), the Centers for Medicare and Medicaid Services (CMS) imposes financial penalties on hospitals for excess 30-day risk- adjusted readmission rates for targeted conditions. Despite seeming initial success with the HRRP, a number of observers have expressed serious concerns over the penalty rules and some have recommended changes to the program. A particular criticism involves the HRRP impact on safety net hospitals (SNHs), which serve a relatively high proportion of low income patients, who have low self-efficacy and a higher probability of readmission. If SNHs are being penalized in part for readmission risk due to socioeconomic factors outside their control, a different policy may be appropriate for these facilities. The ACA specified the penalty formula and ceilings, the timetable for implementation, and the three initial target conditions. This foundation was passed into law; CMS was granted authority to expand the program “as determined appropriate.” To date, assessments of the HRRP largely have examined overall changes in readmissions or have identified hospital features associated with penalties. However, no studies have focused on individual hospital improvement under the program or on the types and characteristics of hospitals that achieved greater reductions in readmissions. By definition, hospitals that had the highest readmission rates received the highest penalties. However receiving the greatest penalties does not equate with achieving the greatest improvement, and the characteristics of hospitals receiving higher penalties do not necessarily correlate with those of the hospitals realizing the greatest readmission reduction. Using descriptive and statistical techniques, this project measures improvement rates for individual hospitals and hospital catchment areas and identifies characteristics associated with greater and with smaller improvement in 30-day readmission rates. Knowledge of what types of hospitals and which populations are achieving the greatest success under the HRRP and of where it has failed to reduce readmissions will provide valuable new information to CMS as it refines the program.