Reducing Readmissions for Chronic Obstructive Pulmonary Disease in Response to the Hospital Readmissions Reduction Program.

RATIONALE: In August 2013, the Hospital Readmission Reduction Program (HRRP) announced financial penalties on hospitals with higher-than-expected risk-adjusted 30-day readmission rates for Medicare beneficiaries hospitalized for chronic obstructive pulmonary disease (COPD) exacerbation. In October 2014, penalties were imposed. We hypothesized that penalties would be associated with decreased readmissions after COPD hospitalizations.

OBJECTIVE: To determine if announcement and enactment of financial penalties for COPD were associated with decreases in hospital readmissions for COPD.

METHODS: We used data from California's Office of Statewide Health Planning and Development to examine unplanned 30-day all-cause and COPD-related readmissions after COPD hospitalization. The pre-announcement period was January 2010-July 2013. The post-announcement period was August 2013-September 2014. The post-enactment period was October 2014-December 2017. Using interrupted time series, we investigated the immediate change after the intervention (level change) and differences in the pre-and post-intervention trends (slope change).

RESULTS: We identified 333,429 index hospitalizations for COPD from 449 California hospitals. Overall, 69% of patients had Medicare insurance. For all-cause readmissions, the level change at announcement was 0.16% (95% CI -1.07, 1.38, P=0.80); the change in slope between pre-announcement and post-announcement periods was -0.01% (95% CI -0.15, 0.13, P=0.92). The level change at enactment was 0.29% (95% CI -1.11, 1.69, P=0.68); the change in slope between post-announcement and post-enactment was 0.04% (95% CI -0.10, 0.18, P=0.57). For patients with COPD-related readmissions, the level change at the time of the announcement was 0.09% (95% CI -0.68, 0.85, P=0.83); the change in slope was 0.003% (95% CI -0.08, 0.09, P=0.94). The level change at the time of the enactment was 0.22% (95% CI -0.69, 1.12, P=0.64); the change in slope was -0.02% (95% CI -0.10, 0.07, P=0.72).

CONCLUSIONS: We did not detect decreases in either all-cause or COPD-related readmission rates at either timepoint. Although this would suggest that HRRP penalty was ineffective for COPD, COPD readmissions had decreased at an earlier timepoint (October 2012), when penalties were announced for conditions other than COPD. Based on this, we believe early, broad interventions decreased readmissions, such that no difference was seen at this later timepoints despite institution of COPD-specific penalties.