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The American Journal of Managed Care December 2018
Feasibility of Expanded Emergency Department Screening for Behavioral Health Problems
Mamata Kene, MD, MPH; Christopher Miller Rosales, MS; Sabrina Wood, MS; Adina S. Rauchwerger, MPH; David R. Vinson, MD; and Stacy A. Sterling, DrPH, MSW
From the Editorial Board: Jonas de Souza, MD, MBA
Jonas de Souza, MD, MBA
Risk Adjusting Medicare Advantage Star Ratings for Socioeconomic Status
Margaret E. O’Kane, MHA, President, National Committee for Quality Assurance
Reducing Disparities Requires Multiple Strategies
Melony E. Sorbero, PhD, MS, MPH; Susan M. Paddock, PhD; and Cheryl L. Damberg, PhD
Cost Variation and Savings Opportunities in the Oncology Care Model
James Baumgardner, PhD; Ahva Shahabi, PhD; Christopher Zacker, RPh, PhD; and Darius Lakdawalla, PhD
Patient Attribution: Why the Method Matters
Rozalina G. McCoy, MD, MS; Kari S. Bunkers, MD; Priya Ramar, MPH; Sarah K. Meier, PhD; Lorelle L. Benetti, BA; Robert E. Nesse, MD; and James M. Naessens, ScD, MPH
Patient Experience During a Large Primary Care Practice Transformation Initiative
Kaylyn E. Swankoski, MA; Deborah N. Peikes, PhD, MPA; Nikkilyn Morrison, MPPA; John J. Holland, BS; Nancy Duda, PhD; Nancy A. Clusen, MS; Timothy J. Day, MSPH; and Randall S. Brown, PhD
Relationships Between Provider-Led Health Plans and Quality, Utilization, and Satisfaction
Natasha Parekh, MD, MS; Inmaculada Hernandez, PharmD, PhD; Thomas R. Radomski, MD, MS; and William H. Shrank, MD, MSHS
Primary Care Burnout and Populist Discontent
James O. Breen, MD
Adalimumab Persistence for Inflammatory Bowel Disease in Veteran and Insured Cohorts
Shail M. Govani, MD, MSc; Rachel Lipson, MSc; Mohamed Noureldin, MBBS, MSc; Wyndy Wiitala, PhD; Peter D.R. Higgins, MD, PhD, MSc; Sameer D. Saini, MD, MSc; Jacqueline A. Pugh, MD; Dawn I. Velligan, PhD; Ryan W. Stidham, MD, MSc; and Akbar K. Waljee, MD, MSc
The Value of Novel Immuno-Oncology Treatments
John A. Romley, PhD; Andrew Delgado, PharmD; Jinjoo Shim, MS; and Katharine Batt, MD
Medicare Advantage Control of Postacute Costs: Perspectives From Stakeholders
Emily A. Gadbois, PhD; Denise A. Tyler, PhD; Renee R. Shield, PhD; John P. McHugh, PhD; Ulrika Winblad, PhD; Amal Trivedi, MD; and Vincent Mor, PhD
Provider-Owned Insurers in the Individual Market
David H. Howard, PhD; Brad Herring, PhD; John Graves, PhD; and Erin Trish, PhD
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Mixed Messages to Consumers From Medicare: Hospital Compare Grades Versus Value-Based Payment Penalty
Jennifer Meddings, MD, MSc; Shawna N. Smith, PhD; Timothy P. Hofer, MD, MSc; Mary A.M. Rogers, PhD, MS; Laura Petersen, MHSA; and Laurence F. McMahon Jr, MD, MPH

Mixed Messages to Consumers From Medicare: Hospital Compare Grades Versus Value-Based Payment Penalty

Jennifer Meddings, MD, MSc; Shawna N. Smith, PhD; Timothy P. Hofer, MD, MSc; Mary A.M. Rogers, PhD, MS; Laura Petersen, MHSA; and Laurence F. McMahon Jr, MD, MPH
Many hospitals penalized for readmissions were given readmission grades of “no different” or “better” than the national rate on the Hospital Compare website.
METHODS

This retrospective secondary data analysis combined publicly reported 2015 Hospital Compare grades data for readmissions within 30 days6 with the Medicare financial penalty data assigned for readmissions over the same time period.7-9 (Data are available by download from CMS websites.6,7) Measures studied included the condition-specific grades assigned by Hospital Compare for HF and AMI, AMI- and HF-specific ERRs, and whether the hospital received an overall readmission penalty. Methods for calculating grades and penalties have been previously published.1,2,5,10 Per CMS policy, 2015 readmissions grades and penalties were based on hospital stays from July 1, 2010, to June 30, 2013, and required the use of a minimum of 25 cases to calculate a hospital’s ERR for each applicable condition.

Given our focus of contrasting penalized hospitals with their corresponding Hospital Compare grade, hospitals not found in both the penalties and grades files were excluded from analysis. By policy, Veterans Affairs and critical access hospitals were excluded, as were Maryland hospitals (which are excluded from the HRRP, as they have been exempted from CMS’s Acute Prospective Payment System since 1977) and Puerto Rico hospitals. Descriptive analyses examined the number of hospitals graded as “better,” “no different,” or “worse” than the national rate for HF and AMI and their corresponding penalization under HRRP. We also examined the range of ERRs associated with each Hospital Compare grade for each of the 5 conditions (ie, HF, AMI, pneumonia, COPD, total hip/knee arthroplasty) and the number of those conditions with ERRs greater than 1 for hospitals receiving an overall readmission penalty. Institutional review board approval was not required because this study used publicly available data not linked to individual human subjects.

RESULTS

There were 4748 hospitals that had readmission data available. The application of exclusion criteria to generate the analytic data set for the HRRP analysis is detailed in the study flow diagram (eAppendix [available at ajmc.com]).4 There were 3134 hospitals that had grade and penalty data available on at least 1 of the 5 readmission measures. For the 2 conditions studied in this analysis (HF, AMI), we provide a graphical representation of 3 types of readmission performance data downloaded from the CMS files for each hospital: (1) the publicly displayed grade for readmission rates on Hospital Compare on the x-axis, as “worse,” “no different,” or “better” than the national rate; (2) the ERR for the condition on the y-axis, with values greater than 1.0 categorized as excessive readmissions; and (3) whether the hospital received an overall financial penalty for readmissions across the 5 targeted conditions, indicated by the hospital’s dot color (light blue indicates penalized; dark blue, not penalized).

HF

Figure 1 displays the ERRs (y-axis) and Hospital Compare grades (x-axis) for HF. There were 2956 hospitals that had publicly reported HF grades on Hospital Compare. Of these, 2534 (85.7%) hospitals were penalized for overall readmissions. Of all 2956 hospitals, 2717 (91.9%) were graded against the national rate as “no different,” 119 (4.0%) were graded as “worse,” and the remaining 120 (4.1%) as “better.” ERRs for hospitals graded as “no different” for HF readmissions ranged from 0.81 to 1.19, with 1321 (48.6%) hospitals having an ERR greater than 1.0. Of the 2717 hospitals, 2355 (86.7%) received an overall readmission penalty. For hospitals graded as “better” than the national rate for HF, 0 had an ERR greater than 1.0 for HF (range, 0.699-0.914), and 60 of 120 (50%) were penalized. All 119 hospitals graded “worse” had HF ERRs greater than 1.0 (range, 1.089-1.389), and 100% were penalized.

AMI

Figure 2 displays the ERRs (y-axis) and Hospital Compare grades (x-axis) for AMI. There were 2178 hospitals that had publicly reported AMI grades on Hospital Compare. Of these, 1895 (87.0%) hospitals were penalized for overall readmissions. Of all 2178 hospitals, 2130 (97.8%) were graded against the national rate as “no different,” 23 (1.1%) were graded as “worse,” and the remaining 25 (1.2%) as “better.” ERRs for hospitals graded as “no different” for AMI readmissions ranged from 0.75 to 1.21 and included 1046 (49.1%) hospitals with ERRs greater than 1.0 for AMI. Of the 2130 hospitals graded as “no different,” 1863 (87.5%) received an overall readmission penalty. For hospitals graded as “better” than the national rate for AMI, 0 had an ERR greater than 1.0 for AMI (range, 0.724-0.879), and 9 of 25 (36%) were penalized. All 23 hospitals graded as “worse” had AMI ERRs greater than 1.0 (range, 1.120 to 1.254), and 100% were penalized.

Penalties as a Function of Number of Conditions With Excess Readmissions

Of the 2591 (82.7%) hospitals that received penalties for overall readmissions, more than half were penalized for having just 1 or 2 of 5 condition-specific ERRs greater than 1.0; 689 (26.6%) had an ERR greater than 1.0 for just 1 condition, and 713 (27.5%) had ERRs greater than 1.0 for just 2 conditions. The largest single ERR driver for penalties was total hip/knee arthroplasty, which accounted for 215 of 689 (31.2%) of the single-condition penalties. For 141 hospitals penalized for readmissions with only an HF ERR greater than 1.0, 140 (99.3%) were graded against the national rate as “no different” for HF readmissions, and 1 (0.7%) was graded as “worse.” There were 82 hospitals that were penalized for excess AMI readmissions only; all 82 were graded as “no different” from the national rate.


 
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