Voluntary value-based reforms help reduce hospital readmissions

Hospital participation in certain voluntary value-based reforms is associated with reduced readmissions under Medicare’s mandatory Hospital Readmission Reduction Program.

HRRP financially penalizes hospitals that have relatively high rates of Medicare readmissions. However, researchers have found that hospitals achieving Meaningful Use under the Medicare and Medicaid Electronic Health Records Incentive Programs or participating in Medicare’s Pioneer and Shared Savings accountable care organizations (ACOs) or Bundled Payment for Care Initiative achieved greater reductions in readmissions under HRRP.

That’s the finding of a new longitudinal study of readmissions data from 2,837 U.S. hospitals gathered between 2008 and 2015. Results of the study were published this week in JAMA Internal Medicine.

ACOs, bundled-payment initiatives and the Meaningful Use program include provider incentives to lower hospital readmissions, either directly or indirectly. The study found that participation in one or more Medicare value-based reforms was associated with greater reductions in 30-day risk-standardized readmission rates for acute myocardial infarction (AMI), heart failure and pneumonia under HRRP.

“The hospitals that reduced readmissions the most were the ones that chose to participate in all three,” says Julia Adler-Milstein, co-author of the article and assistant professor in the School of Information at the University of Michigan.

Hospitals participating in all three voluntary, value-based reform programs reduced their 30-day readmissions by an additional 1.27 percentage points for AMI, 1.64 percentage points for heart failure and 1.05 percentage points for pneumonia. Further, the authors estimate that hospital participation in the three voluntary reforms in 2015 led to 2,377 fewer readmissions, and in the process saved Medicare nearly $33 million.

“But, each of the programs individually also had an impact,” contends Adler-Milstein. “Even if a hospital just did Meaningful Use and nothing else, there was a significant additional reduction in readmissions.”

For instance, hospital participation in the Meaningful Use program alone was associated with an additional reduction in 30-day readmissions of 0.78 percentage points for AMI, 0.97 percentage points for heart failure, and 0.56 percentage points for pneumonia.

In addition, participation in ACO programs alone was associated with an additional reduction in 30-day readmissions of 0.94 percentage points for AMI, 0.83 percentage points for heart failure, and 0.59 percentage points for pneumonia.

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By comparison, for hospitals that did not participate in any voluntary value-based reforms, the association between the HRRP and 30-day readmission was a reduction of 0.76 percentage points for AMI, 1.30 percentage points for heart failure, and 0.82 percentage points for pneumonia.

“There are so many different approaches to reorganizing how we deliver and pay for care,” observes Adler-Milstein. “We’re in a phase where we’re sort of trying to experiment with everything at once because we don’t really know what the magic combination is that’s going to improve quality performance while reducing cost.”

Nonetheless, the article’s authors conclude that their findings “lend support for Medicare’s multipronged strategy to improve hospital quality and value.”

According to the study, in 2010 no hospitals were participating in the Meaningful Use, ACO or Bundled Payment for Care Initiative programs. However, by 2015, only 56 hospitals were not participating in at least one of these value-based programs.

“That’s the beauty of having all these programs happening at once,” adds Adler-Milstein. “If it’s just one program that applies to a relatively small proportion of a hospital’s patient population, it’s hard to justify making wholesale changes. But when you have multiple programs adding the incentives, it really creates a much stronger case for more substantial transformation.”