Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
Missouri Hospital Association, Hospital Industry Data Institute, Jefferson City.
JAMA Intern Med. 2019 Jun 1;179(6):769-776. doi: 10.1001/jamainternmed.2019.0117.
Beginning in fiscal year 2019, Medicare's Hospital Readmissions Reduction Program (HRRP) stratifies hospitals into 5 peer groups based on the proportion of each hospital's patient population that is dually enrolled in Medicare and Medicaid. The effect of this policy change is largely unknown.
To identify hospital and state characteristics associated with changes in HRRP-related performance and penalties after stratification.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis was performed of all 3049 hospitals participating in the HRRP in fiscal years 2018 and 2019, using publicly available data on hospital penalties, merged with information on hospital characteristics and state Medicaid eligibility cutoffs.
The HRRP, under the 2018 traditional method and the 2019 stratification method.
Performance on readmissions, as measured by the excess readmissions ratio, and penalties under the HRRP both in relative percentage change and in absolute dollars.
The study sample included 3049 hospitals. The mean proportion of dually enrolled beneficiaries ranged from 9.5% in the lowest quintile to 44.7% in the highest quintile. At the hospital level, changes in penalties ranged from an increase of $225 000 to a decrease of more than $436 000 after stratification. In total, hospitals in the lowest quintile of dual enrollment saw an increase of $12 330 157 in penalties, while those in the highest quintile of dual enrollment saw a decrease of $22 445 644. Teaching hospitals (odds ratio [OR], 2.13; 95% CI, 1.76-2.57; P < .001) and large hospitals (OR, 1.51; 95% CI, 1.22-1.86; P < .001) had higher odds of receiving a reduced penalty. Not-for-profit hospitals (OR, 0.64; 95% CI, 0.52-0.80; P < .001) were less likely to have a penalty reduction than for-profit hospitals, and hospitals in the Midwest (OR, 0.44; 95% CI, 0.34-0.57; P < .001) and South (OR, 0.42; 95% CI, 0.30-0.57; P < .001) were less likely to do so than hospitals in the Northeast. Hospitals with patients from the most disadvantaged neighborhoods (OR, 2.62; 95% CI, 2.03-3.38; P < .001) and those with the highest proportion of beneficiaries with disabilities (OR, 3.12; 95% CI, 2.50-3.90; P < .001) were markedly more likely to see a reduction in penalties, as were hospitals in states with the highest Medicaid eligibility cutoffs (OR, 1.79; 95% CI, 1.50-2.14; P < .001).
Stratification of the hospitals under the HRRP was associated with a significant shift in penalties for excess readmissions. Policymakers should monitor the association of this change with readmission rates as well as hospital financial performance as the policy is fully implemented.
从 2019 财年开始，医疗保险的住院患者再入院率降低计划（HRRP）根据每家医院患者群体中同时参加医疗保险和医疗补助的人数比例，将医院分为 5 个同行组。这一政策变化的影响在很大程度上尚不清楚。
确定与分层后与 HRRP 相关的绩效和处罚变化相关的医院和州特征。
设计、地点和参与者：使用公开可用的数据对所有 2018 财年和 2019 财年参与 HRRP 的 3049 家医院进行了一项横断面分析，这些数据与医院的处罚情况相关联，并与医院特征和州医疗补助资格截止日期的信息相融合。
2018 年的传统方法和 2019 年的分层方法下的 HRRP。
再入院的表现，通过过度再入院率来衡量，以及 HRRP 下的处罚，包括相对百分比变化和绝对美元变化。
研究样本包括 3049 家医院。双重参保受益人的比例从最低五分位数的 9.5%到最高五分位数的 44.7%不等。在医院层面，分层后，处罚金额从增加 225000 美元到减少超过 436000 美元不等。总的来说，双重参保比例最低的五分之一的医院的罚款增加了 12330157 美元，而双重参保比例最高的五分之一的医院的罚款减少了 22445644 美元。教学医院（比值比[OR]，2.13；95%置信区间[CI]，1.76-2.57；P<0.001）和大型医院（OR，1.51；95%CI，1.22-1.86；P<0.001）更有可能获得减少的处罚。非营利性医院（OR，0.64；95%CI，0.52-0.80；P<0.001）比营利性医院更不可能减少处罚，而中西部（OR，0.44；95%CI，0.34-0.57；P<0.001）和南部（OR，0.42；95%CI，0.30-0.57；P<0.001）的医院比东北部的医院更不可能这样做。来自最贫困社区的患者比例较高的医院（OR，2.62；95%CI，2.03-3.38；P<0.001）和残疾受益人数比例最高的医院（OR，3.12；95%CI，2.50-3.90；P<0.001）更有可能减少处罚，而医疗补助资格截止日期最高的州的医院（OR，1.79；95%CI，1.50-2.14；P<0.001）也是如此。
HRRP 下的医院分层与过度再入院相关的处罚显著变化相关。随着该政策的全面实施，政策制定者应监测这一变化与再入院率以及医院财务表现之间的关联。
