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Observational study assessing changes in timing of readmissions around postdischarge day 30 associated with the introduction of the Hospital Readmissions Reduction Program
  1. Ashwin S Nathan1,2,
  2. Joseph R Martinez3,
  3. Jay Giri1,2,4,
  4. Amol S Navathe4,5
  1. 1Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2Cardiovascular Quality, Outcomes and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania, USA
  5. 5Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Ashwin S Nathan, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA; ashwin.nathan{at}


Background The Hospital Readmissions Reduction Program (HRRP) initially penalised hospitals for excess readmission within 30 days of discharge for acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA) and was expanded in subsequent years to include readmissions for chronic obstructive pulmonary disease, elective total hip arthroplasty, total knee arthroplasty and coronary artery bypass graft surgery. We assessed whether HRRP was associated with delays in readmissions from immediately before the 30-day penalty threshold to just after it.

Methods We included Medicare fee-for-service beneficiaries discharged between 1 January 2007 and 31 October 2015. Readmissions were assessed until December 31, 2015. The study period was divided into three phases: January 2007 to March 2009 (pre-HRRP), April 2009 to September 2012 (implementation) and October 2012 to December 2015 (penalty). We estimated additional readmissions between postdischarge days 31–35 compared with days 26–30 using a negative binomial difference-in-differences model, comparing target HRRP versus non-HRRP conditions at the same hospital in the same month in the pre-HRRP and penalty phases.

Results HRRP was not associated with a significant difference in AMI readmissions between postdischarge days 31–35 versus postdischarge days 26–30 for each hospital in the penalty phase, as compared with non-HRRP conditions and the pre-HRRP phase (p=0.19). There were statistically significant increases in readmissions CHF (0.040%, 95% CI 0.024% to 0.056%, p<0.01), PNA (0.022%, 95% CI 0.002% to 0.042%, p=0.03) and stroke (0.035%, 95% CI 0.010% to 0.060%, p<0.01); however, these readmissions represent <0.01% of readmissions during this time period.

Conclusion We did not identify consistently significant associations between HRRP and delayed readmissions, and importantly, any findings suggesting delayed readmissions were extremely small and unlikely to be clinically relevant.

  • health policy
  • health services research
  • quality improvement
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  • ASN and JRM are joint first authors.

  • ASN and JRM contributed equally.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Data will not be shared.

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