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Should the Hospital Readmissions Reduction Program Add Sepsis?

A recent study argues that sepsis should be added to the Hospital Readmissions Reduction Program because the condition leads to more readmissions and higher costs.

Sepsis-related readmissions should be used in value-based penalty determinations under the Hospital Readmissions Reduction Program, study contends

Source: Thinkstock

- The Medicare Hospital Readmission Reduction Program currently determines value-based penalties on 30-day unplanned readmissions rates for six conditions. But the value-based reimbursement program may be missing a key condition that contributes to more hospital readmissions and higher healthcare costs, a research letter in the Journal of the American Medical Association indicated.

Based on 2013 Nationwide Readmissions Claims Database information, researchers contended that sepsis should be added to the Hospital Readmissions Reduction Program because the condition resulted in more readmissions and greater healthcare costs compared to the four of the program’s six conditions.

“Among medical conditions, sepsis is a leading cause of readmissions and associated costs,” wrote study authors. “Adding sepsis to the Hospital Readmission Reduction Program may lead to development of new interventions to reduce unplanned readmissions and associated costs.”

The Hospital Readmissions Reduction Program currently tracks 30-day unplanned readmissions after an initial hospitalization for the following conditions:

• Acute myocardial infarction (AMI)

• Heart failure

• Pneumonia

• Chronic obstructive pulmonary disease (COPD)

• Elective total hip and/or total knee replacement

• Coronary artery bypass graft (CABG) surgery

The value-based reimbursement program contributed to significantly less hospital readmissions between 2010 and 2015, according to CMS data from September 2016. General readmission rates fell by 8 percent nationally during the time period, resulting in Medicare beneficiaries avoiding nearly 100,000 unnecessary readmissions in 2015 compared to 2010.

Out of the over 1.1 million hospital readmissions studied in the research letter, however, researchers linked sepsis hospitalizations to more unplanned readmissions within 30 days. Sepsis accounted for 12.2 percent of hospital readmissions.

The next condition with the most unplanned readmissions within 30 days was heart failure, but the condition had over 67,600 less readmissions linked to it compared to sepsis during the study period. Heart failure only represented 6.7 percent of hospital readmissions.

Pneumonia rounded out the top three with 5 percent of hospital readmissions, followed by COPD with 4.6 percent of readmissions and AMI with 1.3 percent.

The study did not explore readmission rates for two of the more recent conditions, elective total hip and/or total knee replacement and CABG surgery. CMS added the CABG surgery measure in 2016.

In addition to higher hospital readmission rates, researchers also revealed that sepsis-related readmissions produced greater healthcare costs than readmissions caused by other Hospital Readmissions Reduction Program conditions.

The mean healthcare cost per readmission for a sepsis diagnosis was $10,070, over $500 more than the next highest readmission cost by condition, pneumonia.

Other conditions analyzed in the study had the following mean healthcare costs per hospital readmission:

• Pneumonia - $9,533

• AMI - $9,424

• Heart failure - $9,051

• COPD - $8,417

Higher healthcare costs for sepsis-related hospital readmissions may also stem from longer length of stays for unplanned readmissions. The mean length of stay was 7.4 days, totaling 1 day more than the mean length of stay for all five conditions studied.

Pneumonia had the next longest mean length of stay for an unplanned readmission with 6.7 days, followed by heart failure with 6.4 days, COPD with 6 days, and AMI with 5.7 days.

Based on the readmission rates and healthcare costs connected to sepsis hospitalizations, researchers advised CMS to add the condition to the Hospital Readmissions Reduction Program. The value-based penalties under the program may financially motivate providers to develop strategies for preventing the most common reason for readmissions.

Interventions that target sepsis may also lead to lower healthcare costs, researchers added.

While the research letter argued for including sepsis as a measured condition in the Hospital Readmissions Reduction Program, the value-based initiative will already see some changes in 2019. The 21st Century Cures Act finalized a dual-eligible population adjustment in the program.

Dual-eligible beneficiaries had 24 to 67 percent higher odds of experiencing a hospital readmission, according to a December 2016 report from the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation.

As a result, safety-net hospitals that treat more dual-eligible beneficiaries faced more value-based penalties under the program.

To make penalty determinations fairer to safety-net hospitals, the 21st Century Cures Act included a provision that will allow HHS to divide hospitals into groups based on dual-eligible beneficiary populations and compare hospitals based on similar patient populations.

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