Pay-for-performance programs designed to reduce PCP readmission rates may not be effective, as researchers found little variation in 30-day readmission rates, according to a recent retrospective cohort study published in the Annals of Internal Medicine.
“Prompted by the high cost, poor quality, and hospital variation associated with readmissions, CMS launched the Hospital Readmissions Reduction Program, a pay-for-performance program that encourages hospitals to reduce readmissions by decreasing payments to hospitals with excess readmissions,” Siddhartha Singh, MS, MS, of the Medical College of Wisconsin, and colleagues wrote. “Evidence suggests that the program may have succeeded in reducing readmissions. Nevertheless, rates remain high, and further improvements will require a better understanding of other factors that may inuence readmissions.”
Researchers used data from all Texas Medicare claims between Jan. 1, 2007, and Dec. 31, 2015. Patients included in the study had a PCP with at least 50 hospital admissions during the study period. The study was divided into two cohorts: one that examined 30-day readmission rates, and another to determine if patients were seen by their PCP within 7 days of discharge. Results from 2008 to 2011 were compared with results from 2012 to 2015 to determine the stability of PCP-adjusted readmission rates for those PCPs with data in both time frames.
The primary outcome of the study was any readmission within 30 days of hospital discharge, and the secondary outcome was outpatient evaluation by a PCP within 7 days discharge.
Pay-for-performance programs designed to reduce primary care physician, or PCP, readmission rates may not be effective because of little variation in 30-day readmission rates among primary care physicians, according to a recent retrospective cohort study published in the Annals of Internal Medicine.
Source: Adobe Stock
A total of 565,579 hospital admissions between 2012 and 2015 involving 4,230 PCPs were included in the study. The median number of admissions was 108 per PCP, and the mean risk-standardized rate of readmission was 12.4%.
The 10th percentile of PCP readmission rates was 12.4% compared with 13.4% among the 90th percentile. The 99th percentile had a readmission rate of 14%, only 1.1% higher than the mean readmission rate. The overall rate at which individual PCPs saw their patients within 7 days of hospital discharge was 20.4%.
“This study shows negligible variation in readmission rates among PCPs when patient characteristics are controlled for,” Singh and colleagues wrote. “Primary care physicians do not generate sufcient admissions to expect reasonable power to detect differences by PCPs or by most group practices. Therefore, pay-for-performance programs to reduce readmissions on the basis of variation in readmission rates among PCPs may not be effective.”– by Erin Michael
Disclosures: Singh reports personal fees from AstraZeneca outside the submitted work. Please see study for all other authors’ relevant financial disclosures.