Decline in Hospital Readmissions Not Caused by HRRP

Hospital check in desk

Recent research has attributed the decline in hospital readmissions to the Hospital Readmissions Reduction Program (HRRP). However, a study in HealthAffairs by Warren Alpert Foundation Professor of Health Care Policy J. Michael McWilliams, MD, PhD, assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health Michael Barnett, MD, assistant professor of health policy and management at University of Pittsburgh Eric T. Roberts, PhD, statistical programmer Pasha Hamed, MA, and associate professor of health care policy Ateev Mehrotra, MD, MPH revealed that the readmissions decline may instead be largely due to an overall decline in hospital admissions.

Thirty-day readmission rates should decline as admission rates fall, as fewer admissions per patient mean a lower probability that two admissions will fall within 30 days of each other. When the HRRP was instituted in 2010 it was followed by a progressive decline in 30-day readmission rates through 2014. However, the study suggests that instead of the HRRP, factors responsible for lower hospital admission rates may be the cause of lower readmissions. The downward effect of falling admission rates on readmission rates would also explain why conditions not targeted by the HRRP have seen declining readmission rates similar to conditions that are targeted by the program.

These findings question how much of the readmission rate decline can actually be attributed to readmission-specific incentives and efforts and suggest that the impact of the HRRP, like that of other pay-for-performance programs, has been small.