Federal Hospital Readmissions Reduction Program Intended to Address Readmission Rates for Medicare Patients Has Spill-Over Effect on Patients with Medicaid

Study suggests HRRP also benefited patients not directly targeted by the policy

BOSTON – Preventable hospital readmissions within 30 days of discharge have drawn the attention of policy makers in recent years, given their association with poor outcomes and high costs of care. In an effort to address this problem, the federal Hospital Readmissions Reduction Program (HRRP) was implemented as part of the Affordable Care Act (ACA) in 2012 with the specific goal of targeting Medicare patients.

While some studies suggest an association between the HRRP and a reduction in Medicare readmissions for the three conditions originally targeted by the policy – acute myocardial infarction (heart attack), heart failure, and pneumonia – less is known about readmission trends for these conditions among non-Medicare populations, such as patients with Medicaid or private insurance.

In a new study, a team of researchers at Beth Israel Deaconess Medical Center (BIDMC) led by Robert W. Yeh, MD, MSc, Director of the Smith Center for Outcomes Research in Cardiology at BIDMC, found that implementation of the HRRP was associated with a significant decline in readmissions not just for Medicare patients, but also for Medicaid patients with the three target conditions. The findings, published today in the April issue of Health Affairs, suggest that the HRRP may have had a “spillover” effect of reducing readmissions for patients who were not directly targeted by the policy. The researchers determined the policy had no effect on readmissions among privately insured patients.

“Our main finding is that Medicaid readmissions, which were not the intended target of the HRRP, declined at a significantly faster rate for target conditions after implementation of the HRRP – in addition to Medicare readmissions, the actual intended target of the HRRP,” said Enrico G. Ferro, MD, first-author of the study, a fellow at the Smith Center for Outcomes Research in Cardiology at BIDMC and an internal medicine resident at Brigham and Women’s Hospital. “These findings suggest that the effect of the interventions taken by hospitals to reduce readmissions for Medicare patients may have spilled over to Medicaid patients, and resulted in readmission reductions for the Medicaid population.”

The researchers used data from the Nationwide Readmissions Database that was representative of all hospitalizations in the United States and encompassed all insurance groups, including Medicare, Medicaid and private insurance. Next, they assessed whether there was a significant decline in 30-day readmissions after hospitalizations for heart attack, heart failure and pneumonia among each insurance group, compared to patterns observed for other hospitalizations that were not tied to the policy.

The study found that Medicaid readmissions, in addition to Medicare, also declined at a significantly faster rate after implementation of the HRRP for certain conditions than before HRRP implementation. Despite the significant decline in Medicaid readmissions after HRRP implementation, Medicaid readmission rates remain higher than Medicare readmission rates in the post-HRRP period at 19.6% versus 18.8% at the end of 2014, respectively.

“The findings highlight the system-wide effects that Medicare policies can have on patient care within hospitals,” said Yeh. “Policies that are designed to influence elderly patient care end up influencing care delivered to other patient groups – they really change the way health care is delivered in aggregate. As a result, it is all the more imperative that we carefully evaluate policies that are implemented nationally since their effects are far-reaching.”

Further research is needed to clarify how hospitals have achieved system-wide readmission reductions and to understand trends in post-discharge mortality among Medicaid patients since the implementation of the HRRP.

In addition to Yeh and Ferro, coauthors include Rishi K. Wadhera, MPP, MPhil, Eunhee Choi, PhD, Jordan B. Strom, MD, MSc, and Changyu Shen, PhD – all of BIDMC – as well as Jason H. Wasfy, MD, of Massachusetts General Hospital and Yun Wang of Harvard T. H. Chan School of Public Health.

This work was supported by the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.