National Healthcare Quality and Disparities Report
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- Cardiovascular Conditions (2)
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- (-) Hospital Readmissions (11)
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- (-) Payment (11)
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- Surgery (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 11 of 11 Research Studies DisplayedLoomer L, Rahman M, Mroz TM
Impact of higher payments for rural home health episodes on rehospitalizations.
This article evaluated the impact of higher Medicare payments for rural home health care on rehospitalizations. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries. The authors used Medicare data on postacute HH episodes from 2007 to 2014 to estimate the impact of higher payments on beneficiaries outcomes using difference-in-differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010. Their sample included 5.6 million post acute HH episodes (18% rural). After 2010 30- and 60-day rehospitalization rates declined by 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference-in-difference estimate was 0.29 percentage points and 0.57 percentage points for 30- and 60-day rehospitalization, respectively.
AHRQ-funded; HS027054.
Citation: Loomer L, Rahman M, Mroz TM .
Impact of higher payments for rural home health episodes on rehospitalizations.
J Rural Health 2023 Jun; 39(3):604-10. doi: 10.1111/jrh.12725..
Keywords: Payment, Rural Health, Rural/Inner-City Residents, Hospital Readmissions, Hospitalization
Collins CR, Abel MK, Shui A
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
This study aimed to assess where the largest opportunities for care improvement lay with the bundled payment reimbursement model and how best to identify patients at high risk of suffering costly complications, including hospital readmission. The authors used a cohort of patients from 2014 and 2016 who met inclusion criteria for the Major Bowel Bundled Payment Program and performed a cost analysis to identify opportunities for improved care efficiency. Using the results, they identified readmissions as a target for improvement and then assessed whether the American College of Surgeons' National Surgical Quality Improvement Program surgical risk calculator (ACS NSQIP SRC) could accurately identify patients within the bundled payment population who were at high risk of readmission using a logistic regression model. Patients who were readmitted within 90-days post-surgery were 2.53 times more likely to be high-cost (>$60,000) then non-readmitted patients. However, the ACS NSQIP SRC did not accurately predict patients at high risk of readmission within the first 30 days post-surgery.
AHRQ-funded; HS024532.
Citation: Collins CR, Abel MK, Shui A .
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
Perioper Med 2022 Dec 9;11(1):54. doi: 10.1186/s13741-022-00286-9..
Keywords: Provider Performance, Payment, Hospital Readmissions, Quality Improvement, Quality of Care, Surgery, Medicare, Medicaid
Wilcock AD, Joshi S, Escarce J
Luck of the draw: role of chance in the assignment of Medicare readmissions penalties.
Pay-for-performance programs are one strategy used by health plans to improve the efficiency and quality of care delivered to beneficiaries. Under such programs, providers are often compared against their peers in order to win bonuses or face penalties in payment. The purpose of this study was to investigate the impact luck can have on the assessment of performance, the researchers investigated its role in assigning penalties under Medicare's Hospital Readmissions Reduction Policy (HRRP), a program that penalizes hospitals with excess readmissions.
AHRQ-funded; HS024284.
Citation: Wilcock AD, Joshi S, Escarce J .
Luck of the draw: role of chance in the assignment of Medicare readmissions penalties.
PLoS One 2021 Dec 21;16(12):e0261363. doi: 10.1371/journal.pone.0261363..
Keywords: Medicare, Payment, Hospital Readmissions, Provider Performance, Quality of Care
Hoffman GJ, Yakusheva O
Association between financial incentives in Medicare's hospital readmissions reduction program and hospital readmission performance.
This study compared the outcome of penalties versus rewards to prevent hospital readmission in Medicare’s Hospital Readmissions Reduction Program (HRRP). This retrospective cohort study used Medicare readmissions data from 2823 US short-term acute care hospitals participating in HRRP. Data from pre-HRRP in 2016 was compared with 2016-2019 3-year follow-up readmission performance classified by tertile of hospitals using baseline marginal incentives for 5 HRRP-targeted conditions: acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), pneumonia, and hip and/or knee surgery. Of the 2823 hospitals participating in HRRP from baseline to follow-up, 81% had more than 1 excess readmission for 1 or more applicable condition and 19% did not. Financial incentives ranged from a mean range of $8762 to $58,158 per 1 avoided readmission. Hospitals with greater incentives for readmission avoidance had greater decreases than hospitals with smaller incentives. An additional $5000 in the incentive amount was associated with up to a 26% decrease in readmissions. The findings suggest that incentives work better than penalties to reduce hospital readmissions for those 5 conditions.
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Yakusheva O .
Association between financial incentives in Medicare's hospital readmissions reduction program and hospital readmission performance.
JAMA Netw Open 2020 Apr;3(4):e202044. doi: 10.1001/jamanetworkopen.2020.2044..
Keywords: Medicare, Hospital Readmissions, Provider Performance, Payment, Health Insurance, Hospitals
Kim KL, LI L, Kuang M
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
The objective of this study was to investigate the association between changes in hospital referral patterns to skilled nursing facilities (SNFs) and Hospital Readmissions Reduction Program (HRRP) penalty pressure. Results showed that HRRP did not prompt substantial changes in hospital referral patterns to SNFs, although readmissions for patients referred to SNFs differentially decreased more than for other patients, warranting investigation of other mechanisms underlying readmissions reduction.
AHRQ-funded; HS022882.
Citation: Kim KL, LI L, Kuang M .
Changes in hospital referral patterns to skilled nursing facilities under the Hospital Readmissions Reduction Program.
Med Care 2019 Sep;57(9):695-701. doi: 10.1097/mlr.0000000000001169..
Keywords: Hospitals, Nursing Homes, Hospital Readmissions, Payment, Provider Performance
Chhabra KR, Ibrahim AM, Thumma JR
Impact of Medicare readmissions penalties on targeted surgical conditions.
The authors used Medicare claims to evaluate the effects of the 2013 expansion of the Hospital Readmissions Reduction Program on risk-adjusted readmission rates, episode payments, lengths-of-stay, and observation status use for hip and knee replacement surgery. They found that medical readmission penalties led to readmission reductions for surgical patients, that targeted surgical penalties did not have an additional effect, and that readmission reductions are approaching a point below which further reductions may be unlikely.
AHRQ-funded; HS000053.
Citation: Chhabra KR, Ibrahim AM, Thumma JR .
Impact of Medicare readmissions penalties on targeted surgical conditions.
Health Aff 2019 Jul;38(7):1207-15. doi: 10.1377/hlthaff.2019.00096..
Keywords: Surgery, Hospital Readmissions, Orthopedics, Payment
Kaplan CM, Thompson MP, Waters TM
How have 30-day readmission penalties affected racial disparities in readmissions?: an analysis from 2007 to 2014 in five US states.
The purpose of this study was to examine changes in Black-White disparities in 30-day readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia following the passage and implementation of the Hospital Readmission Reduction Program (HRRP), and to compare disparities across safety-net and non-safety-net hospitals. Prior to the passage of HRRP, Black and White readmission rates and disparities in readmissions were decreasing, with largest reductions at safety-net hospitals. Findings showed that improvements in readmissions have not reversed following the implementation of HRRP. In contrast, disparities continue to persist at non-safety-net hospitals.
AHRQ-funded; HS023783.
Citation: Kaplan CM, Thompson MP, Waters TM .
How have 30-day readmission penalties affected racial disparities in readmissions?: an analysis from 2007 to 2014 in five US states.
J Gen Intern Med 2019 Jun;34(6):878-83. doi: 10.1007/s11606-019-04841-x..
Keywords: Hospital Readmissions, Racial and Ethnic Minorities, Hospitals, Medicare, Payment
Meddings J, Smith SN, Hofer TP
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
This study examined the discrepancy of ratings with hospitals with low readmission grades for heart failure (HF) and acute myocardial infarction (AMI) on the Hospital Compare website, yet received penalties for excessive readmissions under the hospital Readmissions Reduction Program. A retrospective data analysis was conducted of 2956 hospitals that had publicly reported HF grades on Hospital Compare. Of those, 92% were graded as “no different” than the national rate for HD readmissions, yet included 48.6% that were scored as having excessive HF admissions and 87% received an overall readmission penalty. Of the 120 hospitals graded as “better”, none were scored as having excessive HF readmissions and 50% were penalized. There were similar results for AMI.
AHRQ-funded; HS018334; HS019767.
Citation: Meddings J, Smith SN, Hofer TP .
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
Am J Manag Care 2018 Dec;24(12):e399-e403..
Keywords: Medicare, Hospital Readmissions, Heart Disease and Health, Hospitals, Quality of Care, Cardiovascular Conditions, Provider Performance, Payment
Huckfeldt P, Escarce J, Wilcock A
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
After announcement and implementation of the Medicare Hospital Readmissions Reduction Program (HRRP), 30-day readmissions declined rapidly among seniors with heart failure (HF) while 30-day mortality rose. This raised questions about whether the policy was responsible, because lower HF readmission rates have historically been associated with higher mortality. In this study, the investigators compared trends in heart failure (HF) mortality at penalized and nonpenalized hospitals nationally.
AHRQ-funded; HS024284.
Citation: Huckfeldt P, Escarce J, Wilcock A .
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
J Am Coll Cardiol 2018 Nov 13;72(20):2539-40. doi: 10.1016/j.jacc.2018.08.2174..
Keywords: Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Medicare, Hospitals, Provider Performance, Payment
Bhatt SP, Wells JM, Iyer AS
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
This study evaluated whether a comprehensive chronic obstructive pulmonary disease (COPD) multidisciplinary intervention focusing on inpatient, transitional, and outpatient care as part of an institution's Bundled Payments for Care Improvement (BPCI) participation would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs. It concluded that a Medicare BPCI intervention did not reduce 30-day all-cause readmission rates or overall costs after hospitalization for acute exacerbation of COPD.
AHRQ-funded; HS013852.
Citation: Bhatt SP, Wells JM, Iyer AS .
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
Ann Am Thorac Soc 2017 May;14(5):643-48. doi: 10.1513/AnnalsATS.201610-775BC.
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Keywords: Respiratory Conditions, Payment, Hospital Readmissions, Medicare, Quality Improvement
Erickson KF, Winkelmayer WC, Chertow GM
Hemodialysis hospitalizations and readmissions: the effects of payment reform.
The researchers used a retrospective cohort interrupted time-series study design to examine whether the 2004 nephrologist reimbursement reform led to reduced hospitalizations and rehospitalizations. They found no significant change in all-cause hospitalization or rehospitalization and slight reductions in fluid overload hospitalization and rehospitalization following reimbursement reform.
AHRQ-funded; HS019178.
Citation: Erickson KF, Winkelmayer WC, Chertow GM .
Hemodialysis hospitalizations and readmissions: the effects of payment reform.
Am J Kidney Dis 2017 Feb;69(2):237-46. doi: 10.1053/j.ajkd.2016.08.033.
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Keywords: Hospital Readmissions, Hospitalization, Kidney Disease and Health, Payment, Policy