Abstract: PD32-12
Sources of Funding: This work was supported by the American Cancer Society (RSG 12-323-01-CPHPS), the National Cancer Institute (R01 CA168691, R01 CA174768, T32 CA180984) and the National Institute on Aging (R01 AG048071).

Introduction

Readmissions after surgery lead to poorer patient outcomes and increased costs. The Hospital Readmission Reduction Program (HRRP) was developed with the goal of reducing preventable readmission through penalties for hospitals with excess readmission rates for certain targeted conditions. We aim to evaluate the effect of this program on targeted and non-targeted surgical conditions.

Methods

We used a 20% Medicare sample to identify readmissions following targeted (total hip arthroplasty, total knee arthroplasty) and non-targeted (cystectomy, abdominal aortic aneurysm repair, colectomy, lung resection) procedures from 2006 to 2014. Multivariable logistic regression was used to calculate adjusted readmission rates. Changes in hospital level readmission rates were analyzed for three distinct time periods (Pre, Measurement, Penalty) corresponding to the HRRP implementation timeline, using an interrupted time series approach.

Results

We identified 538,293 targeted and 165,432 non-targeted procedures performed at 2,779 hospitals. There was a significant decrease in the odds of readmission for all procedures, except cystectomy (Table) which also had the highest readmission rate at 27%. Prior to the policy, the readmission rate for non-targeted procedures was decreasing faster than that of targeted procedures (Figure). However, this trend reversed during the Measurement period (difference in slope for targeted to non-targeted -0.10 [95% Confidence Interval -0.16 to -0.044]). Neither group had a significant change during the Penalty period.

Conclusions

While the HRRP effectively decreased readmissions for targeted surgery, there was no spillover benefit for non-targeted procedures. To decrease the burden of readmission after cystectomy, future efforts should focus on identifying the interventions that resulted in readmission reduction for targeted procedures and evaluating their effectiveness in this population.

Funding

This work was supported by the American Cancer Society (RSG 12-323-01-CPHPS), the National Cancer Institute (R01 CA168691, R01 CA174768, T32 CA180984) and the National Institute on Aging (R01 AG048071).