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Original Investigation
Health Care Reform
April 10, 2017

Association Between Hospitals’ Engagement in Value-Based Reforms and Readmission Reduction in the Hospital Readmission Reduction Program

Author Affiliations
  • 1Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
  • 2University of Michigan School of Information, Ann Arbor
  • 3RAND Corporation, Santa Monica, California
  • 4Department of Urology, University of Michigan Medical School, Ann Arbor
JAMA Intern Med. Published online April 10, 2017. doi:10.1001/jamainternmed.2017.0518
Key Points

Question  Is hospital participation in voluntary value-based reforms associated with greater improvement under Medicare’s Hospital Readmission Reduction Program?

Findings  In this longitudinal study of 2837 US hospitals between 2008 and 2015, we found that participation in 1 or more Medicare value-based reforms—including the Meaningful Use of Electronic Health Records program, the Accountable Care Organization programs, and the Bundled Payment for Care Initiative—was associated with greater reductions in 30-day risk-standardized readmission rates under the Hospital Readmission Reduction Program.

Meaning  Our findings lend support for Medicare’s multipronged strategy to improve hospital value.

Abstract

Importance  Medicare is experimenting with numerous concurrent reforms aimed at improving quality and value for hospitals. It is unclear if these myriad reforms are mutually reinforcing or in conflict with each other.

Objective  To evaluate whether hospital participation in voluntary value-based reforms was associated with greater improvement under Medicare’s Hospital Readmission Reduction Program (HRRP).

Design, Setting, and Participants  Retrospective, longitudinal study using publicly available national data from Hospital Compare on hospital readmissions for 2837 hospitals from 2008 to 2015. We assessed hospital participation in 3 voluntary value-based reforms: Meaningful Use of Electronic Health Records; the Bundled Payment for Care Initiative episode-based payment program (BPCI); and Medicare’s Pioneer and Shared Savings accountable care organization (ACO) programs. We used an interrupted time series design to test whether hospitals’ time-varying participation in these value-based reforms was associated with greater improvement in Medicare’s HRRP.

Main Outcomes and Measures  Thirty-day risk standardized readmission rates for acute myocardial infarction (AMI), heart failure, and pneumonia.

Results  Among the 2837 hospitals in this study, participation in value-based reforms varied considerably over the study period. In 2010, no hospitals were participating in the meaningful use, ACO, or BPCI programs. By 2015, only 56 hospitals were not participating in at least 1 of these programs. Among hospitals that did not participate in any voluntary reforms, the association between the HRRP and 30-day readmission was −0.76 percentage points for AMI (95% CI, −0.93 to −0.60), −1.30 percentage points for heart failure (95% CI, −1.47 to −1.13), and −0.82 percentage points for pneumonia (95% CI, −0.97 to −0.67). Participation in the meaningful use program alone was associated with an additional change in 30-day readmissions of −0.78 percentage points for AMI (95% CI, −0.89 to −0.67), −0.97 percentage points for heart failure (95% CI, −1.08 to −0.86), and −0.56 percentage points for pneumonia (95% CI, −0.65 to −0.47). Participation in ACO programs alone was associated with an additional change in 30-day readmissions of −0.94 percentage points for AMI (95% CI, −1.29 to −0.59), −0.83 percentage points for heart failure (95% CI, −1.26 to −0.41), and −0.59 percentage points for pneumonia (95% CI, −1.00 to −0.18). Participation in multiple reforms led to greater improvement: participation in all 3 programs was associated with an additional change in 30-day readmissions of −1.27 percentage points for AMI (95% CI, −1.58 to −0.97), −1.64 percentage points for heart failure (95% CI, −2.02 to −1.26), and −1.05 percentage points for pneumonia (95% CI, −1.32 to −0.78).

Conclusions and Relevance  Hospital participation in voluntary value-based reforms was associated with greater reductions in readmissions. Our findings lend support for Medicare’s multipronged strategy to improve hospital quality and value.

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