Hollenbeak Christopher S, Spencer Maureen, Schilling Amber L, Kirschman David, Warye Kathy L, Parvizi Javad
Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania.
Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
JB JS Open Access. 2020 Jul 9;5(3). doi: 10.2106/JBJS.OA.19.00072. eCollection 2020 Jul-Sep.
The U.S. Patient Protection and Affordable Care Act created the Hospital Readmissions Reduction Program (HRRP) and the Hospital-Acquired Condition Reduction Program (HACRP). Under these programs, hospitals face reimbursement reductions for having high rates of readmission and hospital-acquired conditions. This study investigated whether readmission following total joint arthroplasty (TJA) under the HRRP was associated with reimbursement penalties under the HACRP.
Hospital-level data on hospital-acquired conditions, readmissions, and financial penalties were obtained from Definitive Healthcare. Outcomes included receipt of an HACRP penalty and the associated losses in revenue in 2018. Logistic regression and linear regression models were used to determine whether the all-cause, 30-day readmission rate following TJA was associated with the receipt or magnitude of an HACRP penalty.
Among 2,135 private, acute care hospitals, 477 (22.3%) received an HACRP penalty. After controlling for other patient and hospital characteristics, hospitals with a 30-day readmission rate of >3% after TJA had over twice the odds of receiving an HACRP penalty (odds ratio, 2.20; p = 0.043). In addition, hospitals with a readmission rate of >3% after TJA incurred $77,519 more in revenue losses due to HACRP penalties (p = 0.011). These effects were magnified in higher-volume hospitals.
Acute care hospitals in the United States with higher 30-day readmission rates following TJA are more likely to be penalized and to have greater revenue losses under the HACRP than hospitals with lower readmission rates after TJA. This strengthens the incentive to invest in the prevention of readmissions after TJA, for example, through greater efforts to reduce surgical site infections and other modifiable risk factors.
美国《患者保护与平价医疗法案》设立了医院再入院率降低计划（HRRP）和医院获得性疾病降低计划（HACRP）。在这些计划下，医院若再入院率和医院获得性疾病发生率较高，将面临报销削减。本研究调查了在HRRP下全关节置换术（TJA）后的再入院情况是否与HACRP下的报销处罚相关。
从Definitive Healthcare获取关于医院获得性疾病、再入院情况和财务处罚的医院层面数据。结局包括2018年是否收到HACRP处罚以及相关收入损失。使用逻辑回归和线性回归模型来确定TJA后30天全因再入院率是否与HACRP处罚的接受情况或处罚幅度相关。
在2135家私立急症医院中，477家（22.3%）收到了HACRP处罚。在控制了其他患者和医院特征后，TJA后30天再入院率>3%的医院收到HACRP处罚的几率是其他医院的两倍多（优势比，2.20；p = 0.043）。此外，TJA后再入院率>3%的医院因HACRP处罚而产生的收入损失多77519美元（p = 0.011）。这些影响在手术量较大的医院中更为明显。
在美国，TJA后30天再入院率较高的急症医院比TJA后再入院率较低的医院更有可能受到处罚，并且在HACRP下收入损失更大。这强化了投资预防TJA后再入院的动机，例如，通过加大努力减少手术部位感染和其他可改变的风险因素。
