Does Public Reporting of Hospital Readmission Rates Make a Difference?
Since the Centers for Medicare and Medicaid Services (CMS) began publicly reporting 30-day hospital readmission rates in 2009 for patients discharged with acute myocardial infarction (MI), heart failure (HF), or pneumonia, what are changes in 30-day readmission rates?
This was a retrospective analysis of Medicare claims data from 2006-2012 for patients discharged after a hospitalization for MI, HF, pneumonia, chronic obstructive pulmonary disease (COPD), or diabetes. These dates were chosen to permit analysis 3 years before and after the public reporting of risk-standardized hospital readmission rates in June 2009. Since the Medicare public reporting program did not include COPD or diabetes, these hospitalizations served as comparator conditions. The primary outcome of interest was unplanned all-cause 30-day hospital readmissions.
Between July 1, 2006 and June 30, 2012, there were 37,829 hospitalizations for acute MI; 100,189 hospitalizations for HF; 79,076 hospitalizations for pneumonia; 89,091 hospitalizations for COPD; and 17,097 hospitalizations for diabetes at >4,100 hospitals in the United States. When comparing the trend for 30-day readmission rates prior to public reporting to the trend after public reporting, there was no difference for MI (p = 0.72), HF (p = 0.19), or pneumonia (p = 0.21). Similarly, there were no significant differences in the trend for mortality for MI, HF, or pneumonia before and after public reporting. There was a decrease in the trend for HF ED visits from 2.3% to -0.8% (p = 0.007) and observation stays from 15.1% to 4.1% (p = 0.04), but not for the other study groups.
Since CMS began publicly reporting 30-day hospital readmission rates in 2009 for patients discharged for MI, HF, and pneumonia, there has not been a measurable change in 30-day readmission rates for any of these conditions.
This is an important study that examines trends of 30-day outcomes before and after implementation of CMS public reporting. Importantly, this intervention was not associated with any measurable change in 30-day readmission rates. As the authors opine, ‘These findings have important policy implications and suggest that well-conducted trials of quality improvement interventions should be performed prior to widespread dissemination.’
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