title: Reliability of 30-Day Readmission Measures Used in the Hospital Readmission Reduction Program.
abstract: OBJECTIVE
  To assess the reliability of risk-standardized readmission rates (RSRRs) for medical conditions and surgical procedures used in the Hospital Readmission Reduction Program (HRRP).
  
  
  METHODS
  State Inpatient Databases for six states from 2011 to 2013 were used to identify patient cohorts for the six conditions used in the HRRP, which was augmented with hospital characteristic and HRRP penalty data.
  
  
  METHODS
  Hierarchical logistic regression models estimated hospital-level RSRRs for each condition, the reliability of each RSRR, and the extent to which socioeconomic and hospital factors further explain RSRR variation. We used publicly available data to estimate payments for excess readmissions in hospitals with reliable and unreliable RSRRs.
  
  
  RESULTS
  Only RSRRs for surgical procedures exceeded the reliability benchmark for most hospitals, whereas RSRRs for medical conditions were typically below the benchmark. Additional adjustment for socioeconomic and hospital factors modestly explained variation in RSRRs. Approximately 25 percent of payments for excess readmissions were tied to unreliable RSRRs.
  
  
  CONCLUSIONS
  Many of the RSRRs employed by the HRRP are unreliable, and one quarter of payments for excess readmissions are associated with unreliable RSRRs. Unreliable measures blur the connection between hospital performance and incentives, and threaten the success of the HRRP.
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Thompson
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Cameron M
authors.initials: CM
authors.lastname: Kaplan
authors.affiliation: Virginia Commonwealth University, Zion Crossroads, VA.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University, Richmond, VA.
authors.forename: Gloria J
authors.initials: GJ
authors.lastname: Bazzoli
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Waters
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000191:economics; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D014481:United States
keywords: Readmissions; reliability; risk-adjustment