Abstract 027: Comparing Changes in Hospital Readmission Rates by Frequency and Total Financial Penalties Over the First Five Years

Objective: To compare changes in risk-standardized readmission rates (RSRRs) for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PN) between hospitals receiving more frequent or higher total penalties under the Hospital Readmission Reduction Program (HRRP) over the first five years (fiscal year [FY] 2013-2017). Methods: Using publically available HRRP penalty data, we categorized hospitals as receiving penalties in all five years vs. fewer than five years. We also summed the penalty amounts over the first five years by hospital and hospitals based on their quartile of summed penalty amount vs. receiving no penalties. Using generalized linear regression, we estimated the average change in RSRRs for AMI, CHF, and PN by penalty frequency (all years vs. not all years) and amount (quartile of total penalty vs. no penalty) between FY 2013 and FY 2017, adjusting for hospital characteristics in the American Hospital Association Annual Survey and Medicare Impact File (both 2009-2011). Results: There were 3,346 hospitals eligible for HRRP penalties between FY 2013 and FY 2017. From this sample, 1,938 hospitals had RSRRs for AMI in both years, 2,821 hospitals had RSRRs for CHF, and 2,876 hospitals had RSRRs for PN. The average change in RSRRs for AMI, CHF, and PN was -2.8%, -2.8%, and -1.4%, respectively. Declines in RSRRs were greater for hospitals receiving penalties in all five years compared to hospitals penalized fewer than five years in AMI (-0.9%, p<0.001), CHF (-0.9%, p<0.001), and PN (-0.4%, p<0.001). Similarly, hospitals receiving the highest total penalties in the first five years of the HRRP had the largest decline in RSRRs compared to hospitals never receiving a penalty for AMI (-1.2%, p<0.001) and CHF (-0.9%, p<0.001), but not for PN (-0.2%, p = not significant). Conclusions: Hospitals receiving more frequent and higher total penalties had greater reductions in RSRRs for AMI and CHF, and to a lesser extent for PN. Our findings suggest that HRRP penalties did not limit hospitals’ ability to reduce readmissions.