University of Michigan School of Nursing, Ann Arbor, MI, USA.
Med Care Res Rev. 2020 Aug;77(4):334-344. doi: 10.1177/1077558718795745. Epub 2018 Aug 24.
This study aimed (1) to estimate the impact of an incremental reduction in excess readmissions on a hospital's Medicare reimbursement revenue, for hospitals subject to penalties under the Medicare's Hospital Readmissions Reduction Program and (2) to evaluate the economic case for an investment in a readmission reduction program. For 2,465 hospitals with excess readmissions in the Fiscal Year 2016 Hospital Compare data set, we (1) used the Hospital Readmissions Reduction Program statute to estimate hospital-specific Medicare reimbursement gains per an avoided readmission and (2) carried out a pro forma analysis of investment in a broad-scale readmission reduction program under conservative assumptions regarding program effectiveness and using program costs from earlier studies. For an average hospital, avoiding one excess readmission would result in reimbursement gains of $10,000 to $58,000 for Medicare discharges. The economic case for investments in a readmission reduction effort was strong overall, with the possible exception of hospitals with low excess readmissions.
(1) 估算在受《医疗保险医院再入院率削减计划》（Medicare's Hospital Readmissions Reduction Program）处罚的医院中，每减少一次多余再入院对医院医疗保险报销收入的影响；以及 (2) 评估投资再入院率削减计划的经济效益。对于 2016 财年 Hospital Compare 数据集内有多余再入院的 2465 家医院，我们：(1) 使用《医疗保险医院再入院率削减计划法案》，估算每家医院每避免一次再入院可获得的医疗保险报销增益；以及 (2) 在考虑到计划有效性和使用早期研究中的计划成本的保守假设下，对广泛的再入院率削减计划的投资进行了形式分析。对于一家平均医院而言，避免一次多余再入院，可为医疗保险出院患者带来 10000 至 58000 美元的报销增益。总的来说，投资再入院率削减计划的经济效益是可观的，可能除了多余再入院率低的医院之外。
