Medicare's Hospital Readmission Reduction Program reduced fall-related health care use: An unexpected benefit?

Hoffman GJ, Alexander NB, Ha J, Nguyen T, Min LC. Medicare's Hospital Readmission Reduction Program reduced fall-related health care use: An unexpected benefit? Health services research. 2024 Feb 1; 59(1):e14246.

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Abstract:

OBJECTIVE: To assess whether Medicare''s Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall-related injuries (FRIs). DATA SOURCES AND STUDY SETTING: Secondary data from Medicare were used. STUDY DESIGN: Using an event study design, among older ( = 65) Medicare fee-for-service beneficiaries, we assessed changes in 30- and 90-day FRI readmissions before and after HRRP''s announcement (April 2010) and implementation (October 2012) for conditions targeted by the HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) versus "non-targeted" (gastrointestinal) conditions. We tested for modification by hospitals with "high-risk" before HRRP and accounted for potential upcoding. We also explored changes in 30-day FRI readmissions involving emergency department (ED) or outpatient care, care processes (length of stay, discharge destination, and primary care visit), and patient selection (age and comorbidities). DATA COLLECTION: Not applicable. PRINCIPAL FINDINGS: We identified 1.5 million (522,596 pre-HRRP, 514,844 announcement, and 474,029 implementation period) index discharges. After its announcement, HRRP was associated with 12%-20% reductions in 30- and 90-day FRI readmissions for patients with CHF (-0.42 percentage points [ppt], p? = 0.02; -1.53?ppt, p? < 0.001) and AMI (-0.35, p? = 0.047; -0.97, p? = 0.001). Two years after implementation, HRRP was associated with reductions in 90-day FRI readmission for AMI (-1.27?ppt, p? = 0.01) and CHF (-0.98?ppt, p? = 0.02) patients. Results were similar for hospitals at higher versus lower baseline risk of FRI readmission. After HRRP''s announcement, decreases were observed in home health (AMI: -2.43?ppt, p? < 0.001; CHF: -8.83?ppt, p? < 0.001; pneumonia: -1.97?ppt, p? < 0.001) and skilled nursing facility referrals (AMI: -5.95?ppt, p? < 0.001; CHF: -3.19?ppt, p? < 0.001; pneumonia: -10.27?ppt, p? < 0.001). CONCLUSIONS: HRRP was associated with reductions in FRIs, primarily for HF and pneumonia patients. These decreases may reflect improvements in transitional care including changes in post-acute referral patterns that benefit patients at risk for falls.