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Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program

IMPORTANCE: The Hospital Readmissions Reduction Program (HRRP) is a Centers for Medicare and Medicaid Services policy that levies hospital reimbursement penalties based on excess readmissions of patients with 4 medical conditions and 3 surgical procedures. A greater understanding of factors associat...

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Autores principales: Li, Benjamin Y., Urish, Kenneth L., Jacobs, Bruce L., He, Chang, Borza, Tudor, Qin, Yongmei, Min, Hye Sung, Dupree, James M., Ellimoottil, Chad, Hollenbeck, Brent K., Lavieri, Mariel S., Helm, Jonathan E., Skolarus, Ted A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902819/
https://www.ncbi.nlm.nih.gov/pubmed/31755949
http://dx.doi.org/10.1001/jamanetworkopen.2019.16008
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author Li, Benjamin Y.
Urish, Kenneth L.
Jacobs, Bruce L.
He, Chang
Borza, Tudor
Qin, Yongmei
Min, Hye Sung
Dupree, James M.
Ellimoottil, Chad
Hollenbeck, Brent K.
Lavieri, Mariel S.
Helm, Jonathan E.
Skolarus, Ted A.
author_facet Li, Benjamin Y.
Urish, Kenneth L.
Jacobs, Bruce L.
He, Chang
Borza, Tudor
Qin, Yongmei
Min, Hye Sung
Dupree, James M.
Ellimoottil, Chad
Hollenbeck, Brent K.
Lavieri, Mariel S.
Helm, Jonathan E.
Skolarus, Ted A.
author_sort Li, Benjamin Y.
collection PubMed
description IMPORTANCE: The Hospital Readmissions Reduction Program (HRRP) is a Centers for Medicare and Medicaid Services policy that levies hospital reimbursement penalties based on excess readmissions of patients with 4 medical conditions and 3 surgical procedures. A greater understanding of factors associated with the 3 surgical reimbursement penalties is needed for clinicians in surgical practice. OBJECTIVE: To investigate the first year of HRRP readmission penalties applied to 2 surgical procedures—elective total hip arthroplasty (THA) and total knee arthroplasty (TKA)—in the context of hospital and patient characteristics. DESIGN, SETTING, AND PARTICIPANTS: Fiscal year 2015 HRRP penalization data from Hospital Compare were linked with the American Hospital Association Annual Survey and with the Healthcare Cost and Utilization Project State Inpatient Database for hospitals in the state of Florida. By using a case-control framework, those hospitals were separated based on HRRP penalty severity, as measured with the HRRP THA and TKA excess readmission ratio, and compared according to orthopedic volume as well as hospital-level and patient-level characteristics. The first year of HRRP readmission penalties applied to surgery in Florida Medicare subsection (d) hospitals was examined, identifying 60 663 Medicare patients who underwent elective THA or TKA in 143 Florida hospitals. The data analysis was conducted from February 2016 to January 2017. EXPOSURES: Annual hospital THA and TKA volume, other hospital-level characteristics, and patient factors used in HRRP risk adjustment. MAIN OUTCOMES AND MEASURES: The HRRP penalties with HRRP excess readmission ratios were measured, and their association with annual THA and TKA volume, a common measure of surgical quality, was evaluated. The HRRP penalties for surgical care according to hospital and readmitted patient characteristics were then examined. RESULTS: Among 143 Florida hospitals, 2991 of 60 663 Medicare patients (4.9%) who underwent THA or TKA were readmitted within 30 days. Annual hospital arthroplasty volume seemed to follow an inverse association with both unadjusted readmission rates (r = −0.16, P = .06) and HRRP risk-adjusted readmission penalties (r = −0.12, P = .14), but these associations were not statistically significant. Other hospital characteristics and readmitted patient characteristics were similar across HRRP orthopedic penalty severity. CONCLUSIONS AND RELEVANCE: This study’s findings suggest that higher-volume hospitals had less severe, but not significantly different, rates of readmission and HRRP penalties, without systematic differences across readmitted patients.
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spelling pubmed-69028192019-12-24 Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program Li, Benjamin Y. Urish, Kenneth L. Jacobs, Bruce L. He, Chang Borza, Tudor Qin, Yongmei Min, Hye Sung Dupree, James M. Ellimoottil, Chad Hollenbeck, Brent K. Lavieri, Mariel S. Helm, Jonathan E. Skolarus, Ted A. JAMA Netw Open Original Investigation IMPORTANCE: The Hospital Readmissions Reduction Program (HRRP) is a Centers for Medicare and Medicaid Services policy that levies hospital reimbursement penalties based on excess readmissions of patients with 4 medical conditions and 3 surgical procedures. A greater understanding of factors associated with the 3 surgical reimbursement penalties is needed for clinicians in surgical practice. OBJECTIVE: To investigate the first year of HRRP readmission penalties applied to 2 surgical procedures—elective total hip arthroplasty (THA) and total knee arthroplasty (TKA)—in the context of hospital and patient characteristics. DESIGN, SETTING, AND PARTICIPANTS: Fiscal year 2015 HRRP penalization data from Hospital Compare were linked with the American Hospital Association Annual Survey and with the Healthcare Cost and Utilization Project State Inpatient Database for hospitals in the state of Florida. By using a case-control framework, those hospitals were separated based on HRRP penalty severity, as measured with the HRRP THA and TKA excess readmission ratio, and compared according to orthopedic volume as well as hospital-level and patient-level characteristics. The first year of HRRP readmission penalties applied to surgery in Florida Medicare subsection (d) hospitals was examined, identifying 60 663 Medicare patients who underwent elective THA or TKA in 143 Florida hospitals. The data analysis was conducted from February 2016 to January 2017. EXPOSURES: Annual hospital THA and TKA volume, other hospital-level characteristics, and patient factors used in HRRP risk adjustment. MAIN OUTCOMES AND MEASURES: The HRRP penalties with HRRP excess readmission ratios were measured, and their association with annual THA and TKA volume, a common measure of surgical quality, was evaluated. The HRRP penalties for surgical care according to hospital and readmitted patient characteristics were then examined. RESULTS: Among 143 Florida hospitals, 2991 of 60 663 Medicare patients (4.9%) who underwent THA or TKA were readmitted within 30 days. Annual hospital arthroplasty volume seemed to follow an inverse association with both unadjusted readmission rates (r = −0.16, P = .06) and HRRP risk-adjusted readmission penalties (r = −0.12, P = .14), but these associations were not statistically significant. Other hospital characteristics and readmitted patient characteristics were similar across HRRP orthopedic penalty severity. CONCLUSIONS AND RELEVANCE: This study’s findings suggest that higher-volume hospitals had less severe, but not significantly different, rates of readmission and HRRP penalties, without systematic differences across readmitted patients. American Medical Association 2019-11-22 /pmc/articles/PMC6902819/ /pubmed/31755949 http://dx.doi.org/10.1001/jamanetworkopen.2019.16008 Text en Copyright 2019 Li BY et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Li, Benjamin Y.
Urish, Kenneth L.
Jacobs, Bruce L.
He, Chang
Borza, Tudor
Qin, Yongmei
Min, Hye Sung
Dupree, James M.
Ellimoottil, Chad
Hollenbeck, Brent K.
Lavieri, Mariel S.
Helm, Jonathan E.
Skolarus, Ted A.
Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program
title Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program
title_full Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program
title_fullStr Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program
title_full_unstemmed Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program
title_short Inaugural Readmission Penalties for Total Hip and Total Knee Arthroplasty Procedures Under the Hospital Readmissions Reduction Program
title_sort inaugural readmission penalties for total hip and total knee arthroplasty procedures under the hospital readmissions reduction program
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902819/
https://www.ncbi.nlm.nih.gov/pubmed/31755949
http://dx.doi.org/10.1001/jamanetworkopen.2019.16008
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