Hospital Participation in Value-Based Reforms Linked to Lower Readmission Rates

Readmission rates were lower among hospitals that took part in federal value-based reforms such as Meaningful Use, bundled payments for care and accountable care organizations (ACOs), according to an AHRQ-funded study. Using national data from Hospital Compare to examine hospital readmissions for about 2,800 hospitals from 2008 to 2015, researchers found that hospitals participating in all three programs reported the largest readmission declines. For example, hospitals that adopted all three programs compared with those that participated only in the Meaningful Use program reported larger drops in readmissions associated with heart attack (1.27 percentage points vs. 0.78), heart failure (1.64 vs. 0.97) and pneumonia (1.05 vs. 0.56). Hospitals that took part in these reforms in 2015 had nearly 2,400 fewer readmissions and saved Medicare more than $32 million, according to the study in JAMA Internal Medicine. Access the abstract.

2017 Jun 1;177(6):862-868. doi: 10.1001/jamainternmed.2017.0518.

Association Between Hospitals' Engagement in Value-Based Reforms and ReadmissionReduction in the Hospital Readmission Reduction Program.

Ryan AM1, Krinsky S1, Adler-Milstein J2, Damberg CL3, Maurer KA1, Hollingsworth JM4.

Author information

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.