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Invited Commentary
Health Policy
May 31, 2019

A Decade Later, Lessons Learned From the Hospital Readmissions Reduction Program

Author Affiliations
  • 1HOK Architects, New York, New York
  • 2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
  • 3Department of Surgery, University of Michigan, Ann Arbor
JAMA Netw Open. 2019;2(5):e194594. doi:10.1001/jamanetworkopen.2019.4594

The Hospital Readmissions Reduction Program (HRRP) was established as part of the Patient Protection and Affordable Care Act in 2010 in response to reports that readmissions were common, costly, and potentially preventable.1 The policy established financial penalties for hospitals with higher-than-expected readmission rates and initially targeted 3 common medical conditions: heart failure, pneumonia, and acute myocardial infarction. The program was later expanded to other conditions, including total knee replacement and total hip replacement. Early reports widely praised the policy for its effect on readmission rates and for serving as a successful pioneer in alternative payment models. The HRRP not only demonstrated significant reductions in readmission rates for the targeted medical conditions but also had a notable spillover effect to nontargeted conditions,2 including surgical procedures.3 However, later reports raised concerns about the unintended consequences of the policy, including increased rates of mortality and abrupt changes in coded severity.4-6 Taken together, there has been growing desire from payers, health care professionals, policy makers, and patients to better understand the true impact of the HRRP, including its most recent iteration, which adds surgical procedures.

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