The researchers examined Medicare fee-for-service hospitalization data from more than 2,800 hospitals across the country between 2000 and 2013. Based on 30-day readmission rates after initial hospitalization for acute myocardial infarction, congestive heart failure or pneumonia, the researchers categorized hospitals into one of four groups based on the penalties they had incurred under the Hospital Readmission Reduction Program: highest performance (0% penalty), average performance (greater than 0% but less than 0.5% penalty), low performance (equal to or greater than 0.5% but less than 0.99% penalty), and lowest performance (equal to or greater than 0.99% penalty). “We analyzed data from more than 15 million Medicare discharges, said co-senior author Francesca Dominici, PhD, click here for more info Professor of Biostatistics and Senior Associate Dean for Research at Harvard T.H. Chan School of Public Health. We implemented Bayesian hierarchical models to estimate readmission rates for each hospital, accounting for differences in each hospitals patient population. We then used pre-post analysis methods to assess whether there were accelerated reductions in readmission rates within each group after the passage of the reform. It turned out that all groups of Thanks hospitals improved to some degree. Notably, we Ta found that it was the hospitals that were the lowest performers before passage of the Affordable Care Act that went Thank You on to improve the most after being penalized financially. For every 10,000 patients discharged per year, the worst performing hospitals which were penalized the most avoided 95 readmissions they would have had if theyd continued along their current trajectory before the implementation of the law, added Dominici. Its a testament to the fact that hospitals do respond to financial penalties, in particular when these penalties are also tied to publicly reported performance goals. Paying hospitals not just for what they do, but for how well they do thats still a relatively new way of reimbursing hospitals, and it looks to be effective, Yeh added. This work was funded, in part, by grants from the National Institutes of Health (P01 CA 134294, R01 GM111339, R01 ES024332 and K23 HL 118138-01), as well as support from the Massachusetts General Hospital Cardiology Divisions Hassenfeld Scholars Program.
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