Edward Norton

Understanding the relationship between Medicare's Readmission Reduction program and 30-day readmissions among patients in Michigan with private insurance

Research Project Description
Deborah Kaye, David Christopher Miller, Jim Dupree, Chandy Ellimoottil, Edward Norton

Hospital readmissions represent a significant burden for both individual patients and the health system, with related expenditures totaling more than $40 billion annually. In many ways, CMS has led the way in decreasing readmissions by introducing its Hospital Readmission Reduction program (HRRP), which has led to a 17% reduction in readmissions for Medicare patients with select conditions. However, little is known about the impact of this Medicare policy on commercially insured patients, whether risk-adjustment techniques used in HRRP are appropriate for privately-insured patients, and the characteristics of hospitals that decreased readmission rates for both Blue Cross Blue Shield of Michigan (BCBSM) and Medicare beneficiaries after implementation of the Readmissions Reduction program.

We therefore propose a study with the following aims:

1) To examine trends in readmissions before and after implementation of Medicare's Readmission Reduction Program for BCBSM beneficiaries in comparison to Medicare patients, including how adjusting for patient characteristics effects a hospital's relative performance; and

2) To evaluate characteristics, attitudes (i.e., safety culture), and services provided by hospitals in Michigan that successfully reduced readmissions for both BCBSM and Medicare beneficiaries after implementation of HRRP.

This project will have direct effects for patients in Michigan by evaluating whether Medicare policy concurrently impacts rates of readmissions for commercially insured beneficiaries. This work will provide insight to payers on the effects of payer-incentivized quality improvement programs and allow hospital administrators to identify specific operational characteristics and processes of care that are associated with improved performance on hospital readmissions, thereby setting the stage for better care for all patients across the State of Michigan.

Blue Cross Blue Shield of Michigan Foundation
(BCBS Award Letter 2521.PIRAP)

Funding Period: 12/1/2017 to 11/30/2018

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