Do Admission and Readmission Reduction Programs Truly Prevent Hospital Visits?

Hospital readmission rates have declined for patients with medical conditions targeted by the Hospital Readmissions Reduction Program (HRRP), established in 2010. In addition, hospitalizations related to ambulatory care–sensitive conditions (ACSCs), such as dehydration, gastroenteritis, and urinary tract infections, which are avoidable if patients have access to high-quality primary care, have also fallen. But do these reductions affect total hospital visits?

In a retrospective cohort study of >3 million index Medicare hospital stays from 2012 through 2015 for heart failure, acute myocardial infarction, or pneumonia, rates of hospital revisits within 30 days after discharge increased steadily. This increase was due to emergency department visits and hospital observations stays — not considered to be hospital admissions, even though patients often do occupy inpatient hospital beds. This increase was offset only partially by declines in readmissions.

In a second study, researchers reviewed a random sample of 20% of all Medicare inpatient and outpatient claims from 2011 through 2015. They found that 75% of the national decrease in avoidable hospitalizations was offset by increases in observation hospital stays.