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  • HHS: 30-Day Readmissions Are Down – For Real

    Hospital 30-day readmission rates are dropping and, with it, concerns that hospitals are accomplishing the decreases through ramped-up use of "observation status" stays that would allow them to do an end-run around potential readmission penalties. Instead, say Department of Health and Human Services (HHS) researchers, the decreases may be related to actual "behavioral change" in hospitals.

    Focusing on Medicare beneficiaries who are elderly, authors of the study reviewed files for more than 52 million stays in 3,387 hospitals across the country between 2007 and 2015, tracking readmission rates and related conditions. Researchers separated files into 2 groups: stays related to "targeted conditions" to which HHS may apply penalties for higher-than-usual readmission rates, and conditions that were not linked to penalties. The study was published in the New England Journal of Medicine.

    Though total knee arthroplasty (TKA) and total hip arthroplasty (THA) are now included in the HHS list of targeted readmission conditions, during most of the time period studied, targeted conditions only included acute myocardial infarction, heart failure, and pneumonia. TKA and THA readmissions were added in late 2014, and were not included in the study.

    What researchers found was that risk-adjusted rates of 30-day readmissions for targeted conditions have fallen from 21.5% to 17.8% from 2007 to 2015, and from 15.3% to 13.1% for nontargeted conditions. The decline in readmission rates accelerated after the passage of the Affordable Care Act (ACA) in 2009 but slowed somewhat between 2012 and 2015. The 30-day readmission penalty program was not introduced until October 2012.

    Authors of the study also looked at the number of stays that were defined as "observation status," a designation that potentially allows hospitals to avoid defining a stay as a readmission. Some critics of the HHS readmission reduction efforts—known as the Hospital Readmissions Reduction (HRR) program—speculated that hospitals would simply move to a greater use of observation status, and not make any actual progress in reducing readmissions.

    According to researchers, that's not the case. They found that while use of observation status has increased, from 2.6% to 4.7% for targeted conditions and from 2.5% to 4.2% for nontargeted conditions, this increase was happening before ACA was enacted and doesn't account for the drop in 30-day readmissions.

    Researchers also found that observation status rates rose more slowly during the implementation phase of ACA than they did during the later "long-term follow-up period." Authors of the study believe the rates imply that hospitals weren't reacting to the startup of the ACA by rushing to substitute observation status for what would've been called a readmission prior to the law.

    "We saw a steady increase in observation-unit stays during the entire analysis period, with no significant changes at the passage of the ACA," authors write. "It seems likely that the upward trend in observation-service use may be attributable to factors that are largely unrelated to the [HRR], such as whether an inpatient stay would be deemed inappropriate by Medicare recovery audit contractors."

    As for the readmission rates themselves, authors of the study believe the pressure was already on hospitals to reduce readmissions before the enactment of ACA, and the new law "catalyzed behavioral change by many hospitals."


    • " Pressure ", meaning the threat of financial penalties, it the key word. Hospitals have responded by adding a new department to their hospitals in response to the CMS demand. The result is that CMS is saving money on the backs of the hospitals....much as they are doing at our professions expense.

      Posted by Brian P. D'Orazio DPT, MS, OCS on 3/16/2016 10:36 PM

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