Medicare's Hospital Readmission Reduction Program reduced fall-related health care use: An unexpected benefit?

Abstract

Objective: To assess whether Medicare's Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall-related injuries (FRIs). Data Sources and Study Setting: Secondary data from Medicare were used. Study Design: Using an event study design, among older (≥65) Medicare fee-for-service beneficiaries, we assessed changes in 30- and 90-day FRI readmissions before and after HRRP's announcement (April 2010) and implementation (October 2012) for conditions targeted by the HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) versus “non-targeted” (gastrointestinal) conditions. We tested for modification by hospitals with “high-risk” before HRRP and accounted for potential upcoding. We also explored changes in 30-day FRI readmissions involving emergency department (ED) or outpatient care, care processes (length of stay, discharge destination, and primary care visit), and patient selection (age and comorbidities). Data Collection: Not applicable. Principal Findings: We identified 1.5 million (522,596 pre-HRRP, 514,844 announcement, and 474,029 implementation period) index discharges. After its announcement, HRRP was associated with 12%–20% reductions in 30- and 90-day FRI readmissions for patients with CHF (−0.42 percentage points [ppt], p = 0.02; −1.53 ppt, p < 0.001) and AMI (−0.35, p = 0.047; −0.97, p = 0.001). Two years after implementation, HRRP was associated with reductions in 90-day FRI readmission for AMI (−1.27 ppt, p = 0.01) and CHF (−0.98 ppt, p = 0.02) patients. Results were similar for hospitals at higher versus lower baseline risk of FRI readmission. After HRRP's announcement, decreases were observed in home health (AMI: −2.43 ppt, p < 0.001; CHF: −8.83 ppt, p < 0.001; pneumonia: −1.97 ppt, p < 0.001) and skilled nursing facility referrals (AMI: −5.95 ppt, p < 0.001; CHF: −3.19 ppt, p < 0.001; pneumonia: −10.27 ppt, p < 0.001). Conclusions: HRRP was associated with reductions in FRIs, primarily for HF and pneumonia patients. These decreases may reflect improvements in transitional care including changes in post-acute referral patterns that benefit patients at risk for falls.