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https://www.readbyqxmd.com/read/28480598/further-evidence-on-the-system-wide-effects-of-the-hospital-readmissions-reduction-program
#1
Berna Demiralp, Fang He, Lane Koenig
OBJECTIVE: To investigate the potential spillover effects of the Hospital Readmissions Reduction Program (HRRP) on readmissions for nontargeted conditions and patient populations. We examine HRRP effects on nontargeted conditions separately and on non-Medicare populations in Florida and California. DATA SOURCES: From 2007-2013, 100 percent Medicare inpatient claims data, 2007-2013 State Inpatient Database (SID) for Florida, and 2007-2011 SID for California. STUDY DESIGN: We conducted an interrupted time series analysis to estimate the change in 30-day all-cause unplanned readmission trends after the start of HRRP using logistic regression...
May 8, 2017: Health Services Research
https://www.readbyqxmd.com/read/28471510/centers-for-medicare-and-medicaid-services-readmission-reports-inaccurately-describe-an-institution-s-decompensated-heart-failure-admissions
#2
Zachary L Cox, Pikki Lai, Connie M Lewis, Daniel J Lenihan
Hospitals typically use Center for Medicare and Medicaid Services' (CMS) Hospital Readmission Reduction Program (HRRP) administrative reports as the standard of heart failure (HF) admission quantification. We aimed to evaluate the HF admission population identified by CMS HRRP definition of HF hospital admissions compared with a clinically based HF definition. We evaluated all hospital admissions at an academic medical center over 16 months in patients with Medicare fee-for service benefits and age ≥65 years...
May 4, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28461357/most-hospitals-received-annual-penalties-for-excess-readmissions-but-some-fared-better-than-others
#3
Michael P Thompson, Teresa M Waters, Cameron M Kaplan, Yu Cao, Gloria J Bazzoli
The Hospital Readmissions Reduction Program (HRRP) initiated by the Affordable Care Act levies financial penalties against hospitals with excess thirty-day Medicare readmissions. We sought to understand the penalty burden over the program's first five years, focusing on characteristics of hospitals that received penalties during all five years, how penalties changed over time, and the relationship between baseline and subsequent performance. More than half of participating hospitals were penalized by the Centers for Medicare and Medicaid Services in all five years of the program...
May 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28395006/association-between-hospitals-engagement-in-value-based-reforms-and-readmission-reduction-in-the-hospital-readmission-reduction-program
#4
Andrew M Ryan, Sam Krinsky, Julia Adler-Milstein, Cheryl L Damberg, Kristin A Maurer, John M Hollingsworth
Importance: Medicare is experimenting with numerous concurrent reforms aimed at improving quality and value for hospitals. It is unclear if these myriad reforms are mutually reinforcing or in conflict with each other. Objective: To evaluate whether hospital participation in voluntary value-based reforms was associated with greater improvement under Medicare's Hospital Readmission Reduction Program (HRRP). Design, Setting, and Participants: Retrospective, longitudinal study using publicly available national data from Hospital Compare on hospital readmissions for 2837 hospitals from 2008 to 2015...
June 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28027367/association-between-hospital-penalty-status-under-the-hospital-readmission-reduction-program-and-readmission-rates-for-target-and-nontarget-conditions
#5
COMPARATIVE STUDY
Nihar R Desai, Joseph S Ross, Ji Young Kwon, Jeph Herrin, Kumar Dharmarajan, Susannah M Bernheim, Harlan M Krumholz, Leora I Horwitz
Importance: Readmission rates declined after announcement of the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for excess readmissions for acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Objective: To compare trends in readmission rates for target and nontarget conditions, stratified by hospital penalty status. Design, Setting, and Participants: Retrospective cohort study of Medicare fee-for-service beneficiaries older than 64 years discharged between January 1, 2008, and June 30, 2015, from 2214 penalty hospitals and 1283 nonpenalty hospitals...
December 27, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28024302/readmission-rates-after-passage-of-the-hospital-readmissions-reduction-program-a-pre-post-analysis
#6
Jason H Wasfy, Corwin Matthew Zigler, Christine Choirat, Yun Wang, Francesca Dominici, Robert W Yeh
Background: Whether hospitals with the highest risk-standardized readmission rates (RSRRs) subsequently experienced the greatest improvement after passage of the Medicare Hospital Readmissions Reduction Program (HRRP) is unknown. Objective: To evaluate whether passage of the HRRP was followed by acceleration in improvement in 30-day RSRRs after hospitalizations for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia and whether the lowest-performing hospitals had faster acceleration in improvement after passage of the law than hospitals that were already performing well...
March 7, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27929411/a-robust-range-grating-lobe-suppression-method-based-on-image-contrast-for-stepped-frequency-sar
#7
Wen-Bin Gao, Teng Long, Ze-Gang Ding, Yi-Rong Wu
The magnitude error and phase error (MEPE) in the transfer function of a stepped-frequency synthetic aperture radar (SAR) system results in a periodic MEPE in the synthesized wideband waveform (SWW), which induces the grating lobes in the high-resolution range profile (HRRP). In this paper, a robust data-driven grating lobe suppression (GLS) method is proposed. Based on a contrast-based error estimation method and the grating lobes of the brightest scatterers in the SAR image, the periodic MEPE can be robustly estimated using the proposed method...
December 6, 2016: Sensors
https://www.readbyqxmd.com/read/27908393/association-of-30-day-readmission-metric%C3%A2-for-heart-failure-under-the-hospital%C3%A2-readmissions-reduction-program%C3%A2-with-quality-of-care-and%C3%A2-outcomes
#8
Ambarish Pandey, Harsh Golwala, Haolin Xu, Adam D DeVore, Roland Matsouaka, Michael Pencina, Dharam J Kumbhani, Adrian F Hernandez, Deepak L Bhatt, Paul A Heidenreich, Clyde W Yancy, James A de Lemos, Gregg C Fonarow
OBJECTIVES: This study sought to determine whether processes of care and long-term clinical outcomes for heart failure (HF) admissions across Get With The Guidelines-Heart Failure (GWTG-HF) program participating centers differ according to HF-specific risk-adjusted 30-day readmission rates (excess readmission ratio [ERR]) as determined by the Hospital Readmission Reduction Program (HRRP). BACKGROUND: HRRP penalizes hospitals with higher than expected risk-adjusted 30-day readmission rates (ERR >1) for common conditions including HF...
December 2016: JACC. Heart Failure
https://www.readbyqxmd.com/read/27766634/reliability-of-30-day-readmission-measures-used-in-the-hospital-readmission-reduction-program
#9
Michael P Thompson, Cameron M Kaplan, Yu Cao, Gloria J Bazzoli, Teresa M Waters
OBJECTIVE: To assess the reliability of risk-standardized readmission rates (RSRRs) for medical conditions and surgical procedures used in the Hospital Readmission Reduction Program (HRRP). DATA SOURCES: State Inpatient Databases for six states from 2011 to 2013 were used to identify patient cohorts for the six conditions used in the HRRP, which was augmented with hospital characteristic and HRRP penalty data. STUDY DESIGN: Hierarchical logistic regression models estimated hospital-level RSRRs for each condition, the reliability of each RSRR, and the extent to which socioeconomic and hospital factors further explain RSRR variation...
December 2016: Health Services Research
https://www.readbyqxmd.com/read/27755392/the-hospital-score-predicts-potentially-preventable-30-day-readmissions-in-conditions-targeted-by-the-hospital-readmissions-reduction-program
#10
MULTICENTER STUDY
Robert E Burke, Jeffrey L Schnipper, Mark V Williams, Edmondo J Robinson, Eduard E Vasilevskis, Sunil Kripalani, Joshua P Metlay, Grant S Fletcher, Andrew D Auerbach, Jacques D Donzé
BACKGROUND/OBJECTIVES: New tools to accurately identify potentially preventable 30-day readmissions are needed. The HOSPITAL score has been internationally validated for medical inpatients, but its performance in select conditions targeted by the Hospital Readmission Reduction Program (HRRP) is unknown. DESIGN: Retrospective cohort study. SETTING: Six geographically diverse medical centers. PARTICIPANTS/EXPOSURES: All consecutive adult medical patients discharged alive in 2011 with 1 of the 4 medical conditions targeted by the HRRP (acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and heart failure) were included...
March 2017: Medical Care
https://www.readbyqxmd.com/read/27733074/financial-impact-of-ivabradine-on-reducing-heart-failure-penalties-under-the-hospital-readmission-reduction-program
#11
Anuraag R Kansal, Stanimira Krotneva, Ali Tafazzoli, Harshali K Patel, Jeffrey S Borer, Michael Böhm, Michel Komajda, Juan Maya, Luigi Tavazzi, Ian Ford, Adrian Kielhorn
OBJECTIVE: The introduction of the Hospital Readmission Reduction Program (HRRP) has led to renewed interest in developing strategies to reduce 30 day readmissions among patients with heart failure (HF). In this study, a model was developed to investigate whether the addition of ivabradine to a standard-of-care (SoC) treatment regimen for patients with HF would reduce HRRP penalties incurred by a hypothetical hospital with excess 30 day readmissions. RESEARCH DESIGN: A model using a Monte Carlo simulation framework was developed...
February 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/27732093/action-is-the-foundational-key-to-all-success
#12
Elena Barengolts
CMS = Centers for Medicare and Medicaid Services COPD = chronic obstructive pulmonary disease H2H = Hospital-to-Home HF = heart failure HRRP = Hospital Re-admissions Reduction Program.
October 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27556831/opinions-on-the-hospital-readmission-reduction-program-results-of-a-national-survey-of-hospital-leaders
#13
Karen E Joynt, Jose E Figueroa, John Oray, Ashish K Jha
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...
August 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27551097/disulfide-cross-linking-influences-symbiotic-activities-of-nodule-peptide-ncr247
#14
Mohammed Shabab, Markus F F Arnold, Jon Penterman, Andrew J Wommack, Hartmut T Bocker, Paul A Price, Joel S Griffitts, Elizabeth M Nolan, Graham C Walker
Interactions of rhizobia with legumes establish the chronic intracellular infection that underlies symbiosis. Within nodules of inverted repeat-lacking clade (IRLC) legumes, rhizobia differentiate into nitrogen-fixing bacteroids. This terminal differentiation is driven by host nodule-specific cysteine-rich (NCR) peptides that orchestrate the adaptation of free-living bacteria into intracellular residents. Medicago truncatula encodes a family of >700 NCR peptides that have conserved cysteine motifs. NCR247 is a cationic peptide with four cysteines that can form two intramolecular disulfide bonds in the oxidized forms...
September 6, 2016: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/27503972/accounting-for-patients-socioeconomic-status-does-not-change-hospital-readmission-rates
#15
Susannah M Bernheim, Craig S Parzynski, Leora Horwitz, Zhenqiu Lin, Michael J Araas, Joseph S Ross, Elizabeth E Drye, Lisa G Suter, Sharon-Lise T Normand, Harlan M Krumholz
There is an active public debate about whether patients' socioeconomic status should be included in the readmission measures used to determine penalties in Medicare's Hospital Readmissions Reduction Program (HRRP). Using the current Centers for Medicare and Medicaid Services methodology, we compared risk-standardized readmission rates for hospitals caring for high and low proportions of patients of low socioeconomic status (as defined by their Medicaid status or neighborhood income). We then calculated risk-standardized readmission rates after additionally adjusting for patients' socioeconomic status...
August 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27442307/hospital-participation-in-acos-associated-with-other-value-based-program-improvement
#16
David Muhlestein, Tianna Tu, Katelyn de Lisle, Thomas Merrill
OBJECTIVES: This paper analyzes whether hospital participation in an accountable care organization (ACO) impacts a hospital's quality improvement and cost reduction outcomes in other value-based purchasing (VBP) programs, including the Hospital Value-Based Purchasing Program (HVBP), the Hospital Readmissions Reduction Program (HRRP), and the Hospital-Acquired Conditions (HAC) Reduction Program. STUDY DESIGN: Using VBP performance data and Leavitt Partners' ACO data, 2 analyses were performed: 1) a descriptive comparison of VBP performance of hospital ACOs compared with non-ACO hospitals, and 2) a longitudinal analysis of hospitals that became part of an ACO during the second year of performance data...
2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27416886/does-it-pay-to-penalize-hospitals-for-excess-readmissions-intended-and-unintended-consequences-of-medicare-s-hospital-readmissions-reductions-program
#17
Jennifer Mellor, Michael Daly, Molly Smith
To incentivize hospitals to provide better quality care at a lower cost, the Affordable Care Act of 2010 included the Hospital Readmissions Reduction Program (HRRP), which reduces payments to hospitals with excess 30-day readmissions for Medicare patients treated for certain conditions. We use triple difference estimation to identify the HRRP's effects in Virginia hospitals; this method estimates the difference in changes in readmission over time between patients targeted by the policy and a comparison group of patients and then compares those difference-in-differences estimates in patients treated at hospitals with readmission rates above the national average (i...
July 15, 2016: Health Economics
https://www.readbyqxmd.com/read/27311949/indication-for-lower-extremity-revascularization-and-hospital-profiling-of-readmissions
#18
COMPARATIVE STUDY
Andrew A Gonzalez, Celeste G Cruz, Shantanu Dev, Nicholas H Osborne
BACKGROUND: Surgical readmissions are common, costly, and the focus of national quality improvement efforts. Given the relatively high readmission rates among vascular patients, pay-for-performance initiatives such as Medicare's Hospital Readmissions Reduction Program (HRRP) have targeted vascular surgery for increased scrutiny in the near future. Yet, the extent to which institutional case mix influences hospital profiling remains unexplored. We sought to evaluate whether higher readmission rates in vascular surgery are a reflection of worse performance or of treating sicker patients...
August 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27271629/a-novel-monopulse-angle-estimation-method-for-wideband-lfm-radars
#19
Yi-Xiong Zhang, Qi-Fan Liu, Ru-Jia Hong, Ping-Ping Pan, Zhen-Miao Deng
Traditional monopulse angle estimations are mainly based on phase comparison and amplitude comparison methods, which are commonly adopted in narrowband radars. In modern radar systems, wideband radars are becoming more and more important, while the angle estimation for wideband signals is little studied in previous works. As noise in wideband radars has larger bandwidth than narrowband radars, the challenge lies in the accumulation of energy from the high resolution range profile (HRRP) of monopulse. In wideband radars, linear frequency modulated (LFM) signals are frequently utilized...
2016: Sensors
https://www.readbyqxmd.com/read/27261414/vulnerable-hospitals-and-cancer-surgery-readmissions-insights-into-the-unintended-consequences-of-the-patient-protection-and-affordable-care-act
#20
Young Hong, Chaoyi Zheng, Elizabeth Hechenbleikner, Lynt B Johnson, Nawar Shara, Waddah B Al-Refaie
BACKGROUND: Penalties from the Hospital Readmission Reduction Program can push financially strained, vulnerable patient-serving hospitals into additional hardship. In this study, we quantified the association between vulnerable hospitals and readmissions and examined the respective contributions of patient- and hospital-related factors. METHODS: A total of 110,857 patients who underwent major cancer operations were identified from the 2004-2011 State Inpatient Database of California...
July 2016: Journal of the American College of Surgeons
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