Trends in 30-day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act.

Trends in 30-day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act.

Am J Med. 2018 Jul 14;:

Authors: Angraal S, Khera R, Zhou S, Wang Y, Lin Z, Dharmarajan K, Desai NR, Bernheim SM, Drye EE, Nasir K, Horwitz LI, Krumholz HM

Abstract
BACKGROUND: Temporal changes in the readmission rates for patient groups and conditions that were not directly under the purview of Hospital Readmissions Reduction Program (HRRP) can help assess whether efforts to lower readmissions extended beyond targeted patients and conditions.
METHODS: Using Nationwide Readmissions Database (2010-2015), we assessed trends in all-cause readmission rates for one of the 3 HRRP conditions (acute myocardial infarction, heart failure, pneumonia) or conditions not targeted by HRRP in 6 age-insurance groups defined by age-groups (≥65 or <65 years) and payer (Medicare, Medicaid, or private insurance).
RESULTS: In the ≥65-year age-group, readmission rates for those covered by Medicare, private-insurance, and Medicaid decreased annually for acute myocardial infarction (risk-adjusted odds ratio, OR [95%CI], Medicare 0.94 [0.94-0.95], private-insurance 0.95 [0.93-0.97], and Medicaid 0.93 [0.90-0.97]), heart failure (ORs, 0.96 [0.96-0.97], 0.97 [0.96-0.99], and 0.96 [0.94-0.98], for the 3 payers, respectively), and pneumonia (ORs, 0.96 [0.96-0.97), 0.96 [0.95-0.97], and 0.94 [0.92-0.96], respectively). In the <65-year age-group, there was a similar decline in 30-day readmission rates for acute myocardial infarction (risk-adjusted ORs for yearly decrease, Medicare 0.97 [0.96-0.98], private-insurance 0.93 [0.92-0.94], and Medicaid 0.94 [0.92-0.95]), heart failure (ORs, 0.98 [0.97-0.98], 0.97 [0.95-0.98], and 0.96 [0.96-0.97], for the 3 payers, respectively), and pneumonia (ORs, 0.98 [0.97-0.99], 0.98 [0.97-1.00], and 0.98 [0.97-0.99], respectively). In comparison to the targeted conditions, there was a relatively small, but significant, decrease in readmission rates for non-target conditions across all age-insurance groups.
CONCLUSION: There was a significant decline in readmission rates across patient age-insurance groups for the 3 target conditions under the HRRP, as well as a decline in readmission rates for non-target conditions. There appears to be a systematic improvement in readmission rates for patient groups beyond the population of fee-for-service, older, Medicare beneficiaries included in the HRRP.

PMID: 30016636 [PubMed – as supplied by publisher]