Meaningful use, accountable care organizations, and bundled payment initiatives work best together to reduce readmissions, UM research suggests

Ever since the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Readmission Reduction Program (HRRP) in 2012, healthcare organizations all over America have sought to prevent unnecessary hospital readmissions within 30 days of discharge. For some clinical laboratories, this meant performing precise microbiology testing to ensure patients are discharged with prescriptions for oral antibiotics in-hand to combat possible infections. Now, a recent study reports that the effort could be paying off, and clinical laboratories played a critical role.

Research performed at the University of Michigan (UM) has linked lower readmission rates under the HRRP to voluntary value-based programs. The three value-based programs the UM researchers identified as contributing to the successful lowering of hospital readmission rates are:

• Meaningful Use (MU) of certified electronic health record (EHR) technology;
• Accountable Care Organizations (ACOs); and
• The Bundled Payments for Care Improvement Initiative (BPCI).

The UM researchers published their findings in the Journal of the American Medical Association (JAMA) Internal Medicine. It could be the first study to demonstrate that synergistic value-based reward programs facilitate healthcare improvement and efficiency. As opposed to HRRP financial penalties alone that is, according to a UM news release.

Researchers Had No Expectations of Payment Reform Programs

Researchers at UM found that all three programs operating together in 2015 (the last year included in the longitudinal study) resulted in about 2,400 fewer readmissions and a $32-million savings to Medicare, the UM release noted.

The team analyzed data on patients treated at 2,877 hospitals from 2008 through 2015 for:

• Acute myocardial infarction;
• Heart failure; and
• Pneumonia.

Their source of information was publicly available Hospital Compare readmission data.

“We had no real expectations that hospitals’ participation in voluntary reforms would be associated with additional reductions in readmissions. We thought that it was just as likely that hospital participation in meaningful use, accountable care organization programs, or the Bundled Payment for Care [Improvement] Initiative may be distracting to hospitals, limiting readmissions reduction,” stated Andrew Ryan, PhD, in ACEPNow, a publication of the American College of Emergency Physicians (ACEP) in Irving, Texas. Ryan is an Associate Professor, Health Management and Policy, at UM’s School of Public Health.

More Participation Leads to Greater Reduction in Readmissions

Nevertheless, the UM researchers linked more reductions in readmissions based on common diagnoses to value-based “reward-style” programs than to HRRP financial penalties. And the more value-based programs a provider implemented, the greater reduction in hospital readmission rates, the study found.

Nearly all hospitals studied were participating in at least one of the value-based programs by 2015, as compared to no program participants in 2010, when the Affordable Care Act was signed into law, noted a Healthcare Dive article.

The chart above from the Kaiser Family Foundation (KFF) illustrates the reduction in hospital readmissions starting in 2012, which multiple studies have linked to the CMS Hospital Readmission Reduction Program (HRRP). The rates, according to the KFF, are risk adjusted to account for age and certain medical conditions. (Image copyright: Kaiser Family Foundation.

For 56 providers that were not participating in value-based care programs by 2015, researchers found the following readmission reductions also were associated with HRRP:

• 3% drop in heart failure readmissions;
• 76% drop in heart attack readmissions; and
• 82% decline in pneumonia readmissions.

For the majority of providers, however, escalating value-based care program participation resulted in greater readmission rate reductions, the study noted.

Readmission Reductions for Heart Failure Patients

Noting the influence of value-based programs, HealthcareDIVE and FierceHealthcare reported the following results for the heart-failure patients studied:

• ACOs result in 2.1% annual readmission reduction;
• MU participation attributed to a 2.3% drop in annual readmission reduction;
• Involvement in all three programs (ACOs, MU, and bundled payments) result in the largest annual readmission declines for hospitals of 2.9%.

Readmission Reductions for Heart Attack, Pneumonia Patients

For myocardial infarction patients, the study showed these effects from value-based programs on readmission declines:

• 7% from ACO launch;
• 5% associated with MU; and
• 2% readmission reductions when all programs were in effect.

For pneumonia patients, the research suggested these changes in readmission declines were associated with value-based programs:

• 4% from ACO launch;
• 4% due to MU; and
• 9% when all programs were in effect.

The researchers advise that providers, aiming for quality improvement and cost savings, should leverage as many of these programs as possible.

“There is a reason to believe these [value-based] programs are reinforcing the broader push to value-based care. Our findings show the importance of a multi-pronged Medicare strategy to improve quality and value,” noted Ryan in the UM news release.

Clinical Laboratories Play Key Role in Reducing Readmissions

Accurate medical laboratory testing plays a critical role in the success of these hospital readmission reduction programs. Thus, all pathologists and laboratory personnel should congratulate themselves for a job well done. And commit to continuing their outstanding performance.

—Donna Marie Pocius 

Related Information:

Association Between Hospitals’ Engagement in Value-Based Reforms and Readmission Reduction in the Hospital Readmission Reduction Program

Voluntary Value-Based Health Programs Dramatically Reduce Hospital Readmissions

Value-Based Reforms Linked to Readmission Reductions

Hospitals Participating in Value-Based Programs Have Lower Readmission Rates

Study: Value-Based Care Programs Reduce Readmissions

Involving Patient’s Family in Discharge Process Linked to 25% Reduction in Hospital Readmissions

Integrating Caregivers at Discharge Significantly Cuts Patient Readmissions, Pitt Study Finds

Hospitals with Lowest 30-Day Readmission Rates Succeed at Reducing Rates by Improving Care Coordination and Monitoring of Patients After Discharge