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Changes in coding of pneumonia and impact on the Hospital Readmission Reduction Program
Author(s) -
Buxbaum Jason D.,
Lindenauer Peter K.,
Cooke Colin R.,
Nuliyalu Ushapoorna,
Ryan Andrew M.
Publication year - 2019
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13207
Subject(s) - medicine , pneumonia , diagnosis code , retrospective cohort study , cohort , sepsis , emergency medicine , population , environmental health
Objective To evaluate whether changes in diagnosis assignment explain reductions in 30‐day readmission for patients with pneumonia following the Hospital Readmission Reduction Program (HRRP). Data Sources 100 percent MedPAR, 2008‐2015. Study Design Retrospective cohort study of Medicare discharges in HRRP‐eligible hospitals. Outcomes were 30‐day readmission rates for pneumonia under a “narrow” definition (used for the HRRP until October 2015; n = 2 288 644) and a “broad” definition that included certain diagnoses of sepsis and aspiration pneumonia (used since October 2015; n = 3 618 215). We estimated changes in 30‐day readmissions in the pre‐HRRP period (January 2008‐March 2010), the HRRP implementation period (April 2010‐September 2012), and the HRRP penalty period (October 2012‐June 2015). Principal Findings Under the narrow definition, adjusted annual readmission rates changed by +0.07 percentage points (pp) during the pre‐HRRP period (95% CI: −0.03 pp, +0.18 pp), −1.07 pp during HRRP implementation (95% CI: −1.15 pp, −0.99 pp), and −0.09 pp during the penalty period (95% CI: −0.18 pp, −0.00 pp). Under the broad definition, 30‐day readmissions changed by +0.21 pp during the pre‐HRRP period (95% CI: +0.12 pp, +0.30 pp), −1.28 pp during HRRP implementation (95% CI: −1.35 pp, −1.21 pp), and −0.09 pp during the penalty period (95% CI: −0.16 pp, −0.02 pp). Conclusions Changes in the coding of inpatient pneumonia admissions do not explain readmission reduction following the HRRP.