A recently published study found that hospital participation in voluntary, value-based reforms, such as Meaningful Use and Medicare’s Pioneer and Shared Savings ACO program, is associated with greater reductions in 30-day readmissions for patients with three common diagnoses.
The aim of the study, which was published in JAMA Internal Medicine, was to examine whether hospital participation in voluntary value-based reforms was associated with greater improvement under Medicare’s Hospital Readmission Reduction Program (HRRP). The research was led by a team of University of Michigan researchers, including Andrew Ryan, Ph.D., Sam Krinsky and Julia Adler-Milstein, PH.D., from the University of Michigan’s School of Public Health’s Department of Health Management and Policy and School of Information.
The researchers noted in the study that Medicare is experimenting with numerous concurrent reforms aimed at improving quality and value for hospitals, yet it remains unclear if these myriad reforms are mutually reinforcing or in conflict with each other.
The study used publicly available data from Hospital Compare on hospital readmissions for 2,837 hospitals from 2008 to 2015 and researchers assessed hospital participation in three voluntary value-based reforms—Meaningful Use of electronic health records; the bundled payment for care initiative episode-based payment program (BPCI); and Medicare’s Pioneer and Shared Savings accountable care organization (ACO) programs. The measures used in the study were 30-day risk standardized readmission rates for acute myocardial infarction (AMI), heart failure and pneumonia.
The researchers found that hospital participation in one or more voluntary value-based reforms—including the Meaningful Use of Electronic Health Records program, the ACO programs, and the Bundled Payment for Care Initiative—was associated with reductions in 30-day risk-standardized readmissions that were greater than reductions from participation in the HRRP alone. “While other studies have documented the effects of the HRRP on safety net hospitals, to our knowledge, ours is the first to consider whether these effects were enhanced by hospital participation in voluntary value-based reforms,” the researchers wrote.
The researchers also noted that the impact on hospital participation in these voluntary reforms is substantial.
“Combining our estimates with published figures on the number of readmissions and Medicare spending per readmission, we estimate that, across the three targeted diagnoses, in 2015 hospital participation in meaningful use, ACOs, and BPCI programs led to 2,377 fewer readmissions,” and saved Medicare about $33 million, the researchers wrote in the study.
The study findings are subject to different interpretations, according to the researchers. One possibility is that hospitals that engaged in voluntary reforms were more likely to have reduced readmissions as voluntary participation “may be a proxy for hospitals’ capacity and willingness to develop clinical processes to improve quality.”
The researchers also surmised that participation in other voluntary reform programs offered by CMS may have enhanced hospitals infrastructure and strengthened their incentives to reduce readmissions. “Meaningful Use programs may have increased adherence to evidence-based care (eg, the use of post-discharge instructions) while also improving coordination through electronic information exchange, registries, and patient engagement tools, all of which could have reduced admissions,” the researchers wrote.
And the researchers noted in the study that participation in multiple reforms led to additional improvement.
The researchers concluded, “Our study suggests that hospital engagement with voluntary value-based reforms was associated with greater reductions in readmissions. These findings lend support for the Centers for Medicare & Medicaid Services (CMS)’s multipronged strategy to improve hospital value.”
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