Readmissions after inpatient hospitalizations are common, costly and in many cases may be preventable. In 2009, a review of Medicare beneficiaries observed that 19.6% patients were readmitted within 30 days of discharge1. Moreover, the study found that Medicare paid more than $17 billion annually on unplanned rehospitalizations suggesting that readmissions could be an important target for quality improvement. Building on these findings, the Affordable Care Act announced the Hospital Readmission Reduction Program in 2010. Under this policy, hospitals with higher than expected readmissions rates beginning in 2012 for three common medical conditions–myocardial infarction, heart failure, pneumonia—would be subject to payment penalties. A growing number of studies now support that the program has led to significant reductions in readmissions rates for these targeted medical procedures2,3.
Whether or not the Hospital Readmissions Reduction Program had any impact on readmission rates for surgical procedures remains understudied. On the one hand, hospital efforts to prevent readmissions may have been purposefully focused on the targeted medical conditions where penalties were being enforced. In contrast, hospitals may have taken a more comprehensive approach to prevent readmissions by investing in system and network-wide resources that improve coordination of care4. Hospitals would have reason to pursue this broader systems based-approach as the Hospital Readmission Reduction Program had the stated goal of expanding penalties at a future date to additional conditions, including specific surgical procedures. In fact, the most recent evaluation of program identified that several conditions beyond the initial three target medical conditions experienced reduction in readmission rates, suggesting a “spill-over” effect of the policy. Whether or not this spill-over effect exists for specific surgical cohorts, however, remains unknown.
In that context, we designed a study to understand the impact of the Hospital Readmission Reduction Program on both future targeted and non-targeted surgical procedures. In addition to understanding the overall trend in readmission rates before and after the policy, we also explored if the changes in readmission rates could be explained by concurrent changes in length of stay during initial admission, use of observation status or discharge to skilled nursing facility.