10 Years of the Hospital Readmissions Reduction Program-an Analysis of Heart Failure Outcomes in Medicare Fee-for-Service Patients

ABSTRACT

Background Heart failure (HF) is the leading cause of readmissions among Medicare beneficiaries. The Hospital Readmissions Reduction Program (HRRP) passed under the Patient Protection and Affordable Care Act began assessing financial penalties in October 2012 for hospitals with higher-than-expected readmissions for acute myocardial infarction, heart failure and pneumonia among fee-for-service Medicare beneficiaries. Excess HF readmissions have been a dominant driver of HRRP penalties. Methods We obtained data on 30-day readmissions, observation stay rates and mortality rates from January 2006 to December 2021 from the CMS website. Mean, SD and temporal trends were analyzed for intervals before HRRP penalty implementation (January 2006 to September 2012) and after (October 2012 to December 2021). Results The 30-day HF readmission rate was 24.52% [0.48] before HRRP implementation and decreased to 22.35% [0.44] between October 2012 to December 2021, p<0.001. Observation stay rates increased from 1.14% [0.30] to 2.13% [0.23], p<0.001. Risk-adjusted mortality rates increased from 10.56% [0.44] to 11.25% [0.36], p<0.001. Temporal trend analysis showed mortality peaked after HRRP enactment but declined to pre-HRRP levels until an increase during the COVID-19 pandemic. Conclusion HRRP penalties led to reduced 30-day HF readmissions but had the unintended consequence of increased observation stays. Mortality peaked following HRRP penalty implementation and then decreased until 2020. [Formula presented]Copyright © 2023 American College of Cardiology Foundation