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Is mortality readmissions bias a concern for readmission rates under the Hospital Readmissions Reduction Program?

Papanicolas, Irene ORCID: 0000-0002-8000-3185, Orav, E. John and Jha, Ashish K. (2020) Is mortality readmissions bias a concern for readmission rates under the Hospital Readmissions Reduction Program? Health Services Research. ISSN 0017-9124 (In Press)

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Abstract

Objective To determine whether the exclusion of patients who die from adjusted 30-day readmission rates influences readmission rate measures and penalties under the Hospital Readmission Reduction Program (HRRP). Data Sources/Study Setting 100% Medicare fee-for-service claims over the period July 1, 2012 until June 30, 2015. Study Design We examine the 30-day readmission risk across the three conditions targeted by the HRRP: acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia. Using logistic regression, we estimate the readmission risk for three samples of patients: those who survived the 30-day period after their index admission, those who died over the 30-day period, and all patients who were admitted to see how they differ. Data Collection/Extraction Methods We identified and extracted data for Medicare fee-for-service beneficiaries admitted with primary diagnoses of AMI (N=497,931), CHF (N=1,047,552) and pneumonia (N=850,552). Results The estimated hospital readmission rates for the survived and non-survived patients differed by 5-8%, on average. Incorporating these estimates into overall readmission risk for all admitted patients changes the likely penalty status for 9% of hospitals. However, this change is randomly distributed across hospitals and is not concentrated amongst any one type of hospital. Conclusions Not accounting for variations in mortality may result in inappropriate penalties for some hospitals. However, the effect of this bias is low due to low mortality rates among incentivized conditions and appears to be randomly distributed across hospital types.

Item Type: Article
Divisions: Health Policy
Subjects: R Medicine > R Medicine (General)
Date Deposited: 14 Jan 2020 11:00
Last Modified: 28 Jan 2020 00:16
URI: http://eprints.lse.ac.uk/id/eprint/103049

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