Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
JAMA Cardiol. 2021 Mar 1;6(3):332-335. doi: 10.1001/jamacardio.2020.4746.
The Centers for Medicare and Medicaid Services (CMS) use point estimates of 30-day risk-standardized readmission rates (RSRRs) to compare hospitals under the Hospital Readmissions Reduction Program (HRRP). An important characteristic of this measure is that it is a point estimate with a margin of error, which may affect the CMS's ability to accurately evaluate and distinguish hospital performance in the program.
To determine the number and percentage of hospitals with a penalty status misclassified under the HRRP.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the bayesian deconvolution method to estimate the rate of penalty status misclassification for hospitals participating in the HRRP in fiscal year 2019, using data from the CMS Hospital Compare website that were collected between July 1, 2014, and June 30, 2017. Beneficiaries of Medicare fee-for-service coverage who were 65 years or older and hospitalized with acute myocardial infarction, heart failure, or pneumonia in hospitals with 25 or more discharges per condition were included in the data set. Data analysis occurred from November 2019 to July 2020.
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The rate of penalty status misclassification for acute myocardial infarction, heart failure, or pneumonia under the HRRP.
The study included 1633, 2626, and 2705 hospitals for acute myocardial infarction, heart failure, and pneumonia, respectively, that participated in the HRRP in fiscal year 2019. The percentages of hospitals that should have been penalized, but were not, were 20.9% (95% CI, 16.0%-25.8%) for acute myocardial infarction, 13.5% (95% CI, 9.8%-17.2%) for heart failure, and 13.2% (95% CI, 10.3%-16.1%) for pneumonia. In contrast, the percentages of hospitals that were incorrectly penalized by the HRRP were 10.1% (95% CI, 5.8%-14.4%) for acute myocardial infarction, 10.9% (95% CI, 7.2%-14.6%) for heart failure, and 12.3% (95% CI, 9.9%-14.6%) for pneumonia.
The margin of error associated with the 30-day RSRRs resulted in the misclassification of condition-specific penalty status for up to 31% of hospitals. These findings suggest that the hospital-level 30-day RSRR measure may not reliably distinguish hospital performance in the HRRP. This has important implications for CMS value-based programs that use risk-standardized outcomes to evaluate and compare hospital performance.
医疗保险和医疗补助服务中心 (CMS) 使用 30 天风险标准化再入院率 (RSRR) 的点估计值来比较医院在医院再入院减少计划 (HRRP) 下的表现。该措施的一个重要特征是它是一个带有误差幅度的点估计值，这可能会影响 CMS 准确评估和区分计划中医院绩效的能力。
确定在 HRRP 下，被错误归类为处罚状态的医院数量和百分比。
设计、设置和参与者：本横断面研究使用贝叶斯反卷积方法，使用 2019 财年 CMS 医院比较网站上的数据，该数据于 2014 年 7 月 1 日至 2017 年 6 月 30 日之间收集，估计在 HRRP 中具有处罚状态的医院的错误分类率。该数据集包括 Medicare 按服务收费计划的受益人，他们年龄在 65 岁或以上，在急性心肌梗死、心力衰竭或肺炎的情况下在 25 次以上出院的医院住院。数据分析于 2019 年 11 月至 2020 年 7 月进行。
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HRRP 下急性心肌梗死、心力衰竭或肺炎的处罚状态错误分类率。
这项研究包括分别为 1633 家、2626 家和 2705 家医院参加了 2019 财年的 HRRP，这些医院因急性心肌梗死、心力衰竭和肺炎而分别参加了 HRRP。本应受到处罚但未受到处罚的医院比例分别为：急性心肌梗死为 20.9%（95% CI，16.0%-25.8%）、心力衰竭为 13.5%（95% CI，9.8%-17.2%）、肺炎为 13.2%（95% CI，10.3%-16.1%）。相比之下，被 HRRP 错误处罚的医院比例分别为：急性心肌梗死为 10.1%（95% CI，5.8%-14.4%）、心力衰竭为 10.9%（95% CI，7.2%-14.6%）、肺炎为 12.3%（95% CI，9.9%-14.6%）。
与 30 天 RSRR 相关的误差幅度导致多达 31%的医院错误分类了具体疾病的处罚状态。这些发现表明，医院层面的 30 天 RSRR 措施可能无法可靠地区分 HRRP 中的医院绩效。这对使用风险标准化结果来评估和比较医院绩效的 CMS 基于价值的计划具有重要意义。
