When chronic obstructive pulmonary disease (COPD) became a target condition under the Hospital Readmissions Reduction Program (HRRP) in October 2014 — when penalties were first imposed — no reductions in all-cause and COPD-related hospital readmissions were observed. Researchers conducted an uninterrupted time series analysis using data from California’s Office of Statewide Health Planning and Development to examine unplanned 30-day all-cause and COPD-linked readmissions following hospitalization for COPD. Results of the study were published in Annals of the American Thoracic Society.

Hypothesizing that penalties would be associated with decreased readmissions following COPD hospitalizations, investigators sought to establish whether announcement and enactment of financial penalties for COPD were linked to reductions in hospital readmissions for the condition. In this analysis, 2 time points of interest were involved: the announcement of penalties for COPD as a target condition in August 2013 and the enactment of penalties for COPD as a target condition in October 2014. With the use of these 2 time points, investigators created 3 distinct time periods: pre-announcement of penalties for COPD as a target condition: January 2010 to July 2013; post-announcement of penalties for COPD as a target condition before the penalties were actually enacted: August 2013 to September 2014; and post-enactment of penalties for COPD as a target condition: October 2014 to December 2017.

All of the adults evaluated were aged 40 years or older and were admitted to the hospital for exacerbation of COPD. The first hospitalization within 30 days was the only circumstance that was considered a readmission. Patients who were admitted after


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30 days were eligible to contribute a second index hospitalization, which was based on the initial inclusion and exclusion criteria. The primary study outcome was the level change in the interrupted time series for unplanned, all-cause, 30-day readmissions in October 2014 — that is, the difference between the expected and actual readmission rates when the penalties were enacted for COPD as a target condition.

Overall, among 406,887 hospitalizations for COPD, a total of 333,429 index hospitalizations for COPD were identified from 449 California hospitals between 2010 and 2017. The median patient age was 70 years; approximately 57% of the patients were women, 64% were non-Hispanic White, and 69% had Medicare insurance. The majority (56%) of the hospitalizations were between 2 and 4 days in duration; 87% of the patients had more than 1 comorbidity.

For all-cause hospital readmissions, the level change at the announcement was 0.16% (95% CI, -1.07 to 1.38; P =.80). The change in slope between the pre-announcement and post-announcement periods was -0.01% (95% CI, -0.15 to 0.13; P =.92). Further, the level change at enactment was 0.29% (95% CI, -1.11 to 1.69; P =.68). The change in slope between the post-announcement and post-enactment periods was 0.04% (95% CI, -0.10 to 0.18; P =.57).

Among patients with COPD-associated readmissions, the level change at the time of the announcement was 0.09% (95% CI, -0.68 to 0.85; P =.83). The change in slope was 0.003% (95% CI, -0.08 to 0.09; P =.94). Additionally, the level change at the time of the enactment was 0.22% (95% CI, 0-.69 to 1.12; P =.64). The change in slope was -0.02% (95% CI, -0.10 to 0.07; P =.72).

The investigators concluded that the results of this study suggest that the HRRP penalty was ineffective for COPD, with COPD hospital readmissions having decreased at the earlier time point of October 2012 — when penalties had been announced for conditions other than COPD. Additional research is warranted to better understand how the HRRP has changed behavior over time and if any unintended consequences were observed.

Reference

Myers LC, Cash R, Liu VX, Camargo CA Jr. Reducing readmissions for chronic obstructive pulmonary disease in response to the Hospital Readmissions Reduction Program. Ann Am Thorac Soc. Published online January 21, 2021. doi:10.1513/AnnalsATS.202007-786OC