Opinions on the Hospital Readmission Reduction Program: results of a national survey of hospital leaders.

OBJECTIVES To determine the opinions of US hospital leadership on the Hospital Readmissions Reduction Program (HRRP), a national mandatory penalty-for-performance program. STUDY DESIGN We developed a survey about federal readmission policies. We used a stratified sampling design to oversample hospitals in the highest and lowest quintile of performance on readmissions, and hospitals serving a high proportion of minority patients. METHODS We surveyed leadership at 1600 US acute care hospitals that were subject to the HRRP, and achieved a 62% response rate. Results were stratified by the size of the HRRP penalty that hospitals received in 2013, and adjusted for nonresponse and sampling strategy. RESULTS Compared with 36.1% for public reporting of readmission rates and 23.7% for public reporting of discharge processes, 65.8% of respondents reported that the HRRP had a "great impact" on efforts to reduce readmissions. The most common critique of the HRRP penalty was that it did not adequately account for differences in socioeconomic status between hospitals (75.8% "agree" or "agree strongly"); other concerns included that the penalties were "much too large" (67.7%), and hospitals' inability to impact patient adherence (64.1%). These sentiments were each more common in leaders of hospitals with higher HRRP penalties. CONCLUSIONS The HRRP has had a major impact on hospital leaders' efforts to reduce readmission rates, which has implications for the design of future quality improvement programs. However, leaders are concerned about the size of the penalties, lack of adjustment for socioeconomic and clinical factors, and hospitals' inability to impact patient adherence and postacute care. These concerns may have implications as policy makers consider changes to the HRRP, as well as to other Medicare value-based payment programs that contain similar readmission metrics.

目的：确定美国医院领导层对《医院再入院减少计划》（HRRP）这一全国性强制性绩效惩罚计划的看法。 研究设计：我们开展了一项关于联邦再入院政策的调查。我们采用分层抽样设计，对再入院绩效最高和最低的五分之一医院以及服务大量少数族裔患者的医院进行过度抽样。 方法：我们对1600家受HRRP约束的美国急性病治疗医院的领导层进行了调查，回复率为62%。结果根据医院2013年收到的HRRP惩罚金额大小进行分层，并针对无回复情况和抽样策略进行了调整。 结果：与36.1%的人认为再入院率公开报告以及23.7%的人认为出院流程公开报告有影响相比，65.8%的受访者称HRRP对减少再入院的努力有“重大影响”。对HRRP惩罚最常见的批评是它没有充分考虑医院之间社会经济状况的差异（75.8%的人“同意”或“非常同意”）；其他担忧包括惩罚“太大”（67.7%）以及医院无法影响患者的依从性（64.1%）。这些看法在受到较高HRRP惩罚的医院领导层中更为常见。 结论：HRRP对医院领导层减少再入院率的努力产生了重大影响，这对未来质量改进计划的设计具有启示意义。然而，领导层担心惩罚金额大小、缺乏对社会经济和临床因素的调整，以及医院无法影响患者的依从性和急性后期护理。当政策制定者考虑对HRRP以及其他包含类似再入院指标的医疗保险基于价值的支付计划进行变革时，这些担忧可能会产生影响。