title: Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre-Post Analysis.
abstract: BACKGROUND
  Whether hospitals with the highest risk-standardized readmission rates (RSRRs) subsequently experienced the greatest improvement after passage of the Medicare Hospital Readmissions Reduction Program (HRRP) is unknown.
  
  
  OBJECTIVE
  To evaluate whether passage of the HRRP was followed by acceleration in improvement in 30-day RSRRs after hospitalizations for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia and whether the lowest-performing hospitals had faster acceleration in improvement after passage of the law than hospitals that were already performing well.
  
  
  METHODS
  Pre-post analysis stratified by hospital performance groups.
  
  
  METHODS
  U.S. acute care hospitals.
  
  
  METHODS
  15 170 008 Medicare patients discharged alive from 2000 to 2013.
  
  
  METHODS
  Passage of the HRRP.
  
  
  METHODS
  30-day readmission rates after hospitalization for AMI, CHF, or pneumonia for hospitals in the highest-performance (0% penalty), average-performance (>0% and <0.50% penalty), low-performance (≥0.50% and <0.99% penalty), and lowest-performance (≥0.99% penalty) groups.
  
  
  RESULTS
  Of 2868 hospitals serving 1 109 530 Medicare discharges annually, 30.1% were highest performers, 44.0% were average performers, 16.8% were low performers, and 9.0% were lowest performers. After controlling for prelaw trends, an additional 67.6 (95% CI, 66.6 to 68.4), 74.8 (CI, 74.0 to 75.4), 85.4 (CI, 84.0 to 86.8), and 95.1 (CI, 92.6 to 97.5) readmissions per 10 000 discharges were found to have been averted per year in the highest-, average-, low-, and lowest-performance groups, respectively, after passage of the law.
  
  
  CONCLUSIONS
  Inability to distinguish between improvement caused by the magnitude of the penalty or by different levels of health improvement in different patient populations.
  
  
  CONCLUSIONS
  After passage of the HRRP, 30-day RSRRs for myocardial infarction, heart failure, and pneumonia decreased more rapidly than before the law's passage. Improvement was most marked for hospitals with the lowest prelaw performance.
  
  
  BACKGROUND
  National Institutes of Health.
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Wasfy
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Corwin Matthew
authors.initials: CM
authors.lastname: Zigler
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Christine
authors.initials: C
authors.lastname: Choirat
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Francesca
authors.initials: F
authors.lastname: Dominici
authors.affiliation: From Massachusetts General Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D006278:Medicare / Q000331:legislation & jurisprudence*; D009203:Myocardial Infarction / Q000628:therapy; D017063:Outcome Assessment, Health Care; D058991:Patient Protection and Affordable Care Act / Q000331:legislation & jurisprudence*; D010359:Patient Readmission / Q000706:statistics & numerical data* / Q000639:trends; D011014:Pneumonia / Q000628:therapy; D014481:United States