An Examination of How an Avoided Readmission Affects Hospitals Financially

医疗保险的医院再入院减少计划（HRRP），根据《平价医疗法案》推出， 在2013财政年度（FY）实施，对超过30天计划外再入院的医院进行处罚，或 超额再入院率（ERR）大于1。2004年，共收到4.28亿美元的HRRP罚款。 仅2015财年，平均医院罚款超过15万美元。安全网医院和教学 医院（TH）比其他医院受到更多的惩罚。虽然HRRP最近在全国范围内 专家们表示担心， 避免再入院足以引起进一步减少再入院的努力。 虽然这似乎是直观的，避免再入院将避免罚款美元平等地为所有医院， 深层关系复杂。这是因为ERR涉及医院患者的风险调整 疾病的严重程度（平均而言，病情较重的医院相对于 实际再入院）和针对医院规模的调整（当较小的医院避免再入院时 其对ERR的影响小于较大医院的影响）。此外，对于医院来说，罚款有一个上限， 超额再入院率和低于预期再入院率的医院的最低标准。由于患者混合、规模， 和上限/下限，避免的再入院并不总是转化为避免的过度再入院。 避免重新接纳也有其代价。医院放弃医疗保险报销收入， 避免再次住院。SNH和TH可能比其他医院损失更多的患者收入， 他们得到的医疗补助。此外，减少再入院的努力可能需要 在劳动力、行政和管理方面的投资，每个病人出院的费用为130 - 325美元。到目前为止， 然而，避免再入院的全部财务影响和成本效益尚不清楚。 我们的目标是探索重新入院的增量改善的全部财务影响和成本效益 性能首先，我们估计避免再入院的财务影响（目标1）。其次，我们使用 预防再入院成本效益分析的影响估计（目标2）。第三，我们（a）看看这是否 影响因医院类型而异，以及（B）识别与影响相关的因素（目标3a，B）。 创新：我们的研究在使用经验公式来估计财务影响方面具有创新性。 了解了基本的数据生成过程，我们可以精确计算 每个医院避免再入院的惩罚，没有与回归方法相关的偏差。 影响：该项目对患者和医疗保险具有深远的影响。到目前为止，还没有研究表明， 研究了避免重新接纳的财政影响，因此，预防工作是否“值得”， 为自己”。我们的研究将为医院和政策制定者提供预防的经济案例， 在不断变化的HRRP政策环境中为医院和决策者提供信息。

Medicare's Hospital Readmissions Reduction Program (HRRP), introduced under the Affordable Care Act and implemented in Fiscal Year (FY) 2013, penalizes hospitals with excess 30-day unplanned readmissions, or excess readmission ratios (ERR) greater than one. A total of $428 million in HRRP penalties was collected in FY 2015 alone, with the average hospital penalty of over $150,000. Safety-net hospitals (SNHs) and teaching hospitals (THs) penalized more than other hospitals. While HRRP has been credited for a recent nationwide decrease in readmissions, experts have expressed concerns whether the positive financial impact from avoiding readmissions is strong enough to elicit further readmission reduction efforts. While it seems intuitive that avoiding readmissions would avoid penalty dollars equally for all hospitals, the underlying relationship is complex. This is because the ERR involves risk-adjustment for the hospital's patient severity of illness (a hospital with sicker patients on average will have fewer excess readmissions relative to actual readmissions) and adjustment for the size of the hospital (when a smaller hospital avoids a readmission it has a smaller effect on ERR than for a larger hospital). Also, the penalty has a ceiling for hospitals with many excess readmissions and a floor for hospitals with fewer-than-expected readmissions. Due to patient mix, size, and the ceiling/floor, an avoided readmission does not always translate to an avoided excess readmission. Readmission avoidance also has its costs. Hospitals forego Medicare reimbursement revenue from each avoided rehospitalization. SNHs and THs may lose more patient revenue than other hospitals because of supplemental Medicare payments they receive. Moreover, readmission reduction efforts may require investments in labor, administration, and management, costing from $130-$325 per patient discharge. To date, however, the full financial impact and the cost-benefit of an avoided hospital readmission are unknown. Our aim is to explore the full financial impact and cost benefit of an incremental improvement in readmission performance. First, we estimate the financial impact of an avoided readmission (Aim 1). Second, we use the impact estimates in a cost-benefit analysis of readmission prevention (Aim 2). Third, we (a) see whether this impact varies by hospital type and (b) identify factors associated with the impact (Aims 3a, b). Innovation: Our study is innovative in its use of the empirical formula to derive the estimated financial impact. Knowing the underlying data-generating process, we carry out exact calculations of the incremental change in penalty per an avoided readmission for each hospital, without biases associated with the regression approach. Impact: This project has far-reaching implications for patients and Medicare. To date, there is no research that has examined financial implications of an avoided readmission and therefore whether prevention efforts “pay for themselves.” Our study will offer the economic case for prevention for hospitals and policymakers, critical information for hospitals and policymakers in a changing HRRP policy environment.