title: Heart failure is a major contributor to hospital readmission penalties.
abstract: BACKGROUND
  The Hospital Readmissions Reduction Program provides incentives to hospitals to reduce early readmissions for heart failure (HF), acute myocardial infarction (AMI), and pneumonia (PNE).
  
  
  RESULTS
  To examine the contribution of each diagnosis to readmissions penalty size, data were obtained from the Center for Medicare and Medicaid Services, American Hospital Association, and United States Census Bureau including number of cases; readmissions payment adjustment factor (values <1 indicate a penalty for excess readmissions), excess readmission ratio (ERR, or ratio of adjusted predicted readmission based on comorbidities, frailty, and individual patient demographics to expected probability of readmission at an average hospital) for each diagnosis, hospital teaching status, bed number, and zip code socioeconomic status. Of 2,228 hospitals with ≥25 cases per diagnosis, 1,636 received a penalty. Univariate correlation coefficients between penalty and ERR were -0.66, -0.61, and -0.43 for HF, PNE, and AMI, respectively (all P < .001). Correlation between ERRs was greatest for PNE and HF (0.30; P < .001) and weakest for PNE and AMI (0.12; P < .001). In regression analyses, the HF ERR explained the most variance in the penalty (R(2) range 0.21-0.44).
  
  
  CONCLUSIONS
  HF ERR, not the number of cases, was related to penalty magnitude. These findings have implications for the design of hospital-based quality initiatives regarding readmissions.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri.
authors.forename: Andrija
authors.initials: A
authors.lastname: Vidic
authors.affiliation: Department of Neurology and Psychiatry, Saint Louis University School of Medicine, St Louis, Missouri.
authors.forename: John T
authors.initials: JT
authors.lastname: Chibnall
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri. Electronic address: hauptmpj@slu.edu.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hauptman
mesh_terms: D016208:Databases, Factual / Q000331:legislation & jurisprudence / Q000592:standards / Q000639:trends; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D006278:Medicare / Q000331:legislation & jurisprudence* / Q000592:standards* / Q000639:trends; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D010359:Patient Readmission / Q000331:legislation & jurisprudence* / Q000592:standards* / Q000639:trends; D011014:Pneumonia / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Heart failure; Medicare; acute myocardial infarction; hospital readmission