Trends in readmission rates for heart failure patients in California hospitals, 2007 – 2012

Background and Purpose

The Centers for Medicare and Medicaid Services (CMS) initiated the Hospital Readmissions Reduction Program (HRRP) in October 2012 to reduce reimbursements to hospitals with excess readmissions among their Medicare patients for Acute Myocardial Infarction, Heart Failure (HF), and Pneumonia.  Using HF as an example, we sought to explore the early impact of this historic health policy shift in Medicare reimbursements by assessing readmission rates across California (CA) acute care hospitals and by identifying hospital and patient characteristics associated with such changes from 2007 to 2012.

Methods

CA patient discharge data (PDD) was used to identify all adult index admissions to acute care hospitals with a primary diagnosis of HF and any subsequent all-cause 30-day readmission.  Three patient cohorts were analyzed in two-year periods, January 2007 to December 2008 (07/08), January 2009 to December 2010 (09/10), and January 2011 to December 2012 (11/12).  Data were analyzed at both the patient and hospital-level to determine associations with readmission rates. 

Results

The overall statewide readmission rates for HF were 19.77% in 07/08, 19.81% in 09/10, and 19.02% in 11/12.  Average hospital readmissions rates were 18.3% (median = 18.2%) in 07/08, 18.5% (median = 18.2%) in 09/10, and 17.6% (median = 17.8%) in 11/12.  Across the three time periods, gender and race/ethnicity categories demonstrated similar patterns of decreased readmission rates.  Rates for Medi-Cal (CA’s Medicaid program) remained roughly the same, while those for Medicare, self-pay patients, and the privately insured decreased slightly. Among those patients who were readmitted, average time to readmission increased from 12.91 days in 07/08 to 13.02 day in 09/10 to 13.24 days in 11/12.  Most of the decrease in time to readmission seen from 07/08 to 11/12 occurred during the first 15 days post-initial discharge.  Hospitals rates did not differ significantly between periods by teaching status, ownership or bed size; however, rates did vary significantly by geography with rural hospitals experiencing slightly large decreases versus urban hospitals.

Conclusion

HF readmission rates in 2011-2012 have decreased statewide and across CA hospitals since 2007-2008, though this reduction has only been recently observed.  This reduction may have resulted from CMS’ implementation of HRRP.  Preliminary findings suggest that reduction in readmission rates may not be limited to Medicare patients only.