Did the Hospital Readmissions Reduction Program Reduce Readmissions? An Assessment of Prior Evidence and New Estimates
In this article, we provide a comprehensive, empirical assessment of the hypothesis that the Hospital Readmissions Reduction Program (HRRP) affected hospital readmissions. In doing so, we provide evidence as to the validity of prior empirical approaches used to evaluate the HRRP and we present results from a previously unused approach to study this research question—a regression-kink design. Results of our analysis document that the empirical approaches used in most prior research assessing the efficacy of the HRRP often lack internal validity. Therefore, results from these studies may not be informative about the causal consequences of the HRRP. Results from our regression-kink analysis, which we validate, suggest that the HRRP had little effect on hospital readmissions. This finding contrasts with the results of most prior studies, which report that the HRRP significantly reduced readmissions. Our finding is consistent with conceptual considerations related to the assumptions underlying HRRP penalty; in particular, the difficulty of identifying preventable readmissions, the highly imperfect risk adjustment that affects the penalty determination and the absence of proven tools to reduce readmissions.
Partial funding for this research was provided by the Agency for Health Research and Quality (AHRQ) under award R01 HS025586. We thank Atul Gupta for sharing information about the analysis in Gupta (2021). The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.
Engy Ziedan & Robert Kaestner, 2021. "Did the Hospital Readmissions Reduction Program Reduce Readmissions? An Assessment of Prior Evidence and New Estimates," Evaluation Review, vol 45(6), pages 359-411. citation courtesy of