Profiling Improvement under the Hospital Readmissions Reduction Program

项目摘要/摘要 根据ACA的再入院减少计划(HRRP)，医疗保险中心 医疗补助服务(CMS)对超过30天风险的医院施加经济处罚- 调整了目标条件下的再住院率。尽管在这方面似乎取得了初步的成功 一些观察员对处罚规则和一些人表示严重关切 已经建议对该计划进行修改。一个特别的批评涉及到HRRP的影响 在为低收入患者提供相对较高比例服务的安全网医院(SNH)方面， 他们的自我效能感较低，再次入院的概率较高。如果SNH受到惩罚 部分原因是由于他们控制之外的社会经济因素造成的重新入院风险，不同的政策 可能适合这些设施。ACA规定了处罚公式和最高限额， 实施时间表，以及三个初步目标条件。这个基础是 通过成为法律；CMS被授予扩展该计划的权力 恰如其分。“到目前为止，对人力资源政策方案的评估主要审查了#年的总体变化。 重新入院或已确定与处罚相关的医院特征。然而，没有研究表明 专注于该计划下的个别医院改进或类型和 再次住院率下降幅度较大的医院的特点。根据定义， 再住院率最高的医院受到的处罚最高。然而， 接受最大处罚并不等同于取得最大进步，以及 接受较高处罚的医院的特点不一定与 实现最大限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 并确定与较大和较小相关的特征 30天再住院率的提高。了解哪些类型的医院和哪些医院 在HRRP下，人们正在取得最大的成功，但在这方面却失败了 减少重新接纳将为CMS提供有价值的新信息，因为它正在完善该计划。

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.