1 Florida International University, Miami, FL, USA.
2 Harvard Medical School, Boston, MA, USA.
Med Care Res Rev. 2019 Oct;76(5):643-660. doi: 10.1177/1077558717744611. Epub 2017 Dec 3.
This study examines whether the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excess readmissions for certain conditions, has reduced hospital readmissions and led to unintended consequences. Our analyses of Florida hospital administrative data between 2008 and 2014 find that the HRRP resulted in a reduction in the likelihood of readmissions by 1% to 2% for traditional Medicare (TM) beneficiaries with heart failure, pneumonia, or chronic obstructive pulmonary disease. Readmission rates for Medicare Advantage (MA) beneficiaries and privately insured patients with heart attack and heart failure decreased even more than TM patients with the same target condition (e.g., for heart attack, the likelihood for TM beneficiaries to be remitted is 2.2% higher than MA beneficiaries and 2.3% higher than privately insured patients). We do not find any evidence of cost-shifting, delayed readmission, or selection on discharge disposition or patient income. However, the HRRP reduced the likelihood of Hispanic patients with target conditions being admitted by 2% to 4%.
这项研究考察了医院再入院率降低计划（HRRP）是否减少了医院再入院率，并带来了意想不到的后果，该计划对某些情况下再入院率过高的医院进行处罚。我们对佛罗里达州 2008 年至 2014 年医院管理数据的分析发现，HRRP 使传统医疗保险（TM）受益人心力衰竭、肺炎或慢性阻塞性肺疾病患者的再入院可能性降低了 1%至 2%。医疗保险优势（MA）受益人和患有心脏病和心力衰竭的私人保险患者的再入院率甚至比具有相同目标条件的 TM 患者更低（例如，对于心脏病发作，TM 受益人的豁免可能性比 MA 受益人和私人保险患者分别高 2.2%和 2.3%）。我们没有发现任何成本转移、延迟再入院或出院处置或患者收入选择的证据。然而，HRRP 使具有目标条件的西班牙裔患者入院的可能性降低了 2%至 4%。
