Mandated report: Effects of the Hospital Readmissions Reduction - - PowerPoint PPT Presentation

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Mandated report: Effects of the Hospital Readmissions Reduction - - PowerPoint PPT Presentation

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Mandated report: Effects of the Hospital Readmissions Reduction Program Craig Lisk and Jeff Stensland March 1, 2018 The 21 st Century Cures Act mandated readmissions study Mandated study question: Are reduced readmissions related to

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SLIDE 1

Mandated report: Effects of the Hospital Readmissions Reduction Program

Craig Lisk and Jeff Stensland March 1, 2018

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The 21st Century Cures Act mandated readmissions study

  • Mandated study question: Are reduced

readmissions “related to changes in

  • utpatient and emergency services”?
  • This report examines relationships between

changes in readmissions and

  • Observation stays
  • Emergency department visits
  • Mortality

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SLIDE 3

Refinements to the draft report

In response to the January meeting’s discussion:

  • Use non-HRRP conditions as the comparison group

in the graphics

  • Examined change in rate of decline in hospital

readmissions before and after program enactment

  • Readmission rates declined faster after program enactment
  • Added discussion to the chapter
  • Updated the literature review
  • Findings unchanged

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SLIDE 4

Raw readmission rates after passage of the HRRP

Results are preliminary and subject to change 4 0.167 0.168 0.167 0.168 0.164 0.159 0.156 0.158 0.150

0.00 0.02 0.04 0.06 0.08 0.10 0.12 0.14 0.16 0.18 0.20

2008 2009 2010 2011 2012 2013 2014 2015 2016

Unplanned readmission rate No HRRP PPACA passes HRRP penalties begin

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SLIDE 5

Raw readmission rates declined for each condition covered by HRRP

Results are preliminary and subject to change 5

0.00 0.05 0.10 0.15 0.20 0.25 0.30 2008 2009 2010 2011 2012 2013 2014 2015 2016

Unplanned readmission rate AMI Heart failure Pneumonia COPD Hip and knee replacement Other conditions No HRRP PPACA passes HRRP penalties begin

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SLIDE 6

Risk-adjusted readmission rates fell faster for conditions covered by the HRRP

Results are preliminary and subject to change 6

0.00 0.05 0.10 0.15 0.20 0.25 0.30

2008 2009 2010 2011 2012 2013 2014 2015 2016

Unplanned readmission rate

AMI Heart failure Pneumonia COPD Hip and knee replacement Other conditions No HRRP PPACA passes HRRP penalties begin

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SLIDE 7

Growth in observation and ED use was not driven by the HRRP program

  • Overall observation and ED visits increased from 2010 to

2016 (overall, meaning not just post-discharge visits)

  • Observation stays overall increased by 1.9 per 100 beneficiaries
  • ED visits overall increased by 5.4 visits per 100 beneficiaries
  • Growth in use of observation and ED began before the

HRRP passed

  • Similar growth for beneficiaries without an admission,

suggesting the HRRP program did not drive the increase

7 Results are preliminary and subject to change

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Risk-adjusted use of observation and ED grew the same for conditions covered and not covered by the HRRP

Results are preliminary and subject to change 8

  • 3.1
  • 2.5

1.1 1.0 2.1 2.1 0.1 0.6

  • 4.0
  • 3.0
  • 2.0
  • 1.0

0.0 1.0 2.0 3.0

5 initial conditions Conditions not included in HRRP

Percentage point change, 2010 to 2016

Risk-adjusted unplanned readmission rate 8 hour plus observation (post-discharge) ED (post-discharge) Return to the hospital (sum of all three)

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SLIDE 9

Raw mortality rates, 2008 to 2016

Results are preliminary and subject to change 9

0.00 0.05 0.10 0.15 0.20 0.25 2008 2009 2010 2011 2012 2013 2014 2015 2016 Raw mortality rate AMI Heart failure Pneumonia Non-HRRP conditions No HRRP PPACA passes HRRP penalties begin

Note: Raw mortality includes in-hospital and 30 days after discharge

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SLIDE 10

Risk-adjusted mortality rates declined from 2008 to 2016

Results are preliminary and subject to change 10 0.00 0.05 0.10 0.15 0.20 0.25 2008 2009 2010 2011 2012 2013 2014 2015 2016 Risk-adjusted mortality rate AMI Heart failure Pneumonia Non-HRRP conditions

No HRRP PPACA passes HRRP penalties begin

Note: Risk-adjusted mortality includes in-hospital and 30 days after discharge

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SLIDE 11

Readmission policy refinements

  • Refine the penalty formula (eliminate the multiplier)
  • Expand to all conditions to pay for fixing the penalty

formula

  • Fixed target
  • Adjust penalties to account for SES (implemented as part
  • f the 21st Century Cures Act)

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Readmission program has been largely successful

  • The HRRP created an incentive to reduce readmissions
  • Readmissions declined (at least partially due to the

HRRP)

  • Observation and emergency visits increased, but may be

largely due to reasons other than the HRRP

  • HRRP did not appear to negatively affect mortality rates
  • While successful, the HRRP still could be refined

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