<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=133753460593199&amp;ev=PageView&amp;noscript=1">

FOTO Rehab Outcomes Blog

Hospital Engagement in Value Based Reforms and Readmission Reduction

 

Although I know this particular article is not about rehabilitation, I really was curious if the various programs Medicare has implemented has created the desired change.

The reforms focused on in this article focused on meaningful use of electronic medical records, bundled payment for care and accountable care organizations. The growth of these initiatives is amazing. If this article is correct, in 2010 no hospital was participating in any initiative and by 2015 only 56 hospitals were not participating in at least one of the programs. 

If I understand the statistics correctly, the meaningful use program provided poorer results than not participating in any program. In some areas, the stats are actually worse. Participation in ACO alone really didn't seem to be a huge difference compared to not participating at all. Participating in all 3 programs did result in a change.

Now, the question I have, if the change was in the 1-1.5% range for reducing readmissions, was that the desired outcome? Did that level of reduction outweigh the costs associated with each program? (Costs for hospitals and costs associated with building the infrastructure and the meetings involved with designing and monitoring the programs?)

Maybe I am misinterpreting what I've read. If you have thoughts, definitely enlighten me.

Below you will find a quick view of the abstract. 

hospital_readmission_rates_value_based_programs

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

 

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.

2017 Apr 10. doi: 10.1001/jamainternmed.2017.0518. [Epub ahead of print]

\