From the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, DC (R.B.Z., K.E.J.M., S.H.S., L.M.C.); Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital - both in Boston (K.E.J.M., A.M.E.); and the Division of Internal Medicine, Department of Internal Medicine, Center for Healthcare Outcomes and Policy, and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (L.M.C.).
N Engl J Med. 2017 Oct 19;377(16):1551-1558. doi: 10.1056/NEJMsa1701791.
The Hospital Readmissions Reduction Program penalizes hospitals that have high 30-day readmission rates across specific conditions. There is support for changing to a hospital-wide readmission measure to broaden hospital eligibility and provide incentives for improvement across more conditions.
We used Medicare claims from 2011 through 2013 to evaluate the number of hospitals that were eligible for penalties, in that they met a volume threshold of 25 admissions over a 3-year period for a specific condition or 25 admissions over a 1-year period for the cohorts included in the hospital-wide measure. We estimated the expected effects that changing from the condition-specific readmission measures to a hospital-wide measure would have on average penalties for safety-net hospitals (i.e., hospitals that treat a large proportion of low-income patients) and other hospitals.
Our sample included 6,807,899 admissions for the hospital-wide measure and 4,392,658 admissions for the condition-specific measures. Of 3443 hospitals, 688 were considered to be safety-net hospitals. Changing to the hospital-wide measure would result in 76 more hospitals being eligible to receive penalties. The hospital-wide measure would increase penalties (mean [±SE] Medicare payment reductions across all hospitals) from 0.42±0.01% to 0.89±0.01% of Medicare base diagnosis-related-group payments. It would also increase the disparity in penalties between safety-net hospitals and other hospitals from -0.03±0.02 to 0.41±0.06 percentage points.
A transition to a hospital-wide readmission measure would only modestly increase the number of hospitals eligible for penalties and would substantially increase the penalties for safety-net hospitals.
医院再入院率降低计划对再入院率高的特定条件下的医院进行处罚。有人支持改用全院范围的再入院衡量标准，以扩大医院的资格，并为改善更多条件提供激励。
我们使用了 2011 年至 2013 年的医疗保险索赔数据，评估了符合处罚条件的医院数量，这些医院在特定条件下的 3 年期间内有 25 次入院，或在包括在全院措施中的队列中在 1 年内有 25 次入院。我们估计了从特定条件的再入院衡量标准改为全院衡量标准对（即治疗大量低收入患者的医院）和其他医院的安全网医院的平均处罚的预期影响。
我们的样本包括全院措施的 6807899 次入院和特定条件措施的 4392658 次入院。在 3443 家医院中，有 688 家被认为是安全网医院。改为全院措施将使 76 家医院有资格接受处罚。全院措施将使（所有医院的医疗保险支付减少的平均值[±SE]）从 0.42±0.01%增加到 0.89±0.01%的医疗保险基础诊断相关组支付。它还将使安全网医院和其他医院之间的处罚差异从-0.03±0.02增加到 0.41±0.06 个百分点。
向全院再入院措施的转变只会适度增加有资格接受处罚的医院数量，并将大大增加安全网医院的处罚。
