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https://www.readbyqxmd.com/read/29148921/a-predictive-model-for-readmissions-among-medicare-patients-in-a-california-hospital
#1
Ian Duncan, Nhan Huynh
Predictive models for hospital readmission rates are in high demand because of the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP). The LACE index is one of the most popular predictive tools among hospitals in the United States. The LACE index is a simple tool with 4 parameters: Length of stay, Acuity of admission, Comorbidity, and Emergency visits in the previous 6 months. The authors applied logistic regression to develop a predictive model for a medium-sized not-for-profit community hospital in California using patient-level data with more specific patient information (including 13 explanatory variables)...
November 17, 2017: Population Health Management
https://www.readbyqxmd.com/read/29128869/association-of-the-hospital-readmissions-reduction-program-implementation-with-readmission-and-mortality-outcomes-in-heart-failure
#2
Ankur Gupta, Larry A Allen, Deepak L Bhatt, Margueritte Cox, Adam D DeVore, Paul A Heidenreich, Adrian F Hernandez, Eric D Peterson, Roland A Matsouaka, Clyde W Yancy, Gregg C Fonarow
Importance: Public reporting of hospitals' 30-day risk-standardized readmission rates following heart failure hospitalization and the financial penalization of hospitals with higher rates have been associated with a reduction in 30-day readmissions but have raised concerns regarding the potential for unintended consequences. Objective: To examine the association of the Hospital Readmissions Reduction Program (HRRP) with readmission and mortality outcomes among patients hospitalized with heart failure within a prospective clinical registry that allows for detailed risk adjustment...
November 12, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29028756/financial-performance-of-hospitals-in-the-mississippi-delta-region-under-the-hospital-readmissions-reduction-program-and-hospital-value-based-purchasing-program
#3
Hsueh-Fen Chen, Saleema Karim, Fei Wan, Adrienne Nevola, Michael E Morris, T Mac Bird, J Mick Tilford
BACKGROUND: Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. OBJECTIVE: To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals)...
November 2017: Medical Care
https://www.readbyqxmd.com/read/28991951/an-opportunity-to-improve-medicare-s-planned-readmissions-measure
#4
Chad Ellimoottil, Roger K Khouri, Apoorv Dhir, Hechuan Hou, David C Miller, James M Dupree
In the Hospital Readmission Reduction Program (HRRP), the Centers for Medicare & Medicaid Services (CMS) utilizes a planned/unplanned algorithm to prevent hospitals from being penalized for scheduled rehospitalizations. We evaluated version 3.0 of the CMS planned readmission algorithm and hypothesized that some readmissions categorized as planned by the HRRP algorithm may actually be unplanned. We identified 143,054 index admissions and 16,116 thirty- day readmissions for 131 hospitals. Only 1252 readmissions were considered planned according to Medicare's readmission algorithm...
October 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28726751/an-adaptive-feature-learning-model-for-sequential-radar-high-resolution-range-profile-recognition
#5
Xuan Peng, Xunzhang Gao, Yifan Zhang, Xiang Li
This paper proposes a new feature learning method for the recognition of radar high resolution range profile (HRRP) sequences. HRRPs from a period of continuous changing aspect angles are jointly modeled and discriminated by a single model named the discriminative infinite restricted Boltzmann machine (Dis-iRBM). Compared with the commonly used hidden Markov model (HMM)-based recognition method for HRRP sequences, which requires efficient preprocessing of the HRRP signal, the proposed method is an end-to-end method of which the input is the raw HRRP sequence, and the output is the label of the target...
July 20, 2017: Sensors
https://www.readbyqxmd.com/read/28717900/elements-of-program-design-in-medicare-s-value-based-and-alternative-payment-models-a-narrative-review
#6
Karen E Joynt Maddox, Aditi P Sen, Lok Wong Samson, Rachael B Zuckerman, Nancy DeLew, Arnold M Epstein
Increasing emphasis on value in health care has spurred the development of value-based and alternative payment models. Inherent in these models are choices around program scope (broad vs. narrow); selecting absolute or relative performance targets; rewarding improvement, achievement, or both; and offering penalties, rewards, or both. We examined and classified current Medicare payment models-the Hospital Readmissions Reduction Program (HRRP), Hospital Value-Based Purchasing Program (HVBP), Hospital-Acquired Conditions Reduction Program (HACRP), Medicare Advantage Quality Star Rating program, Physician Value-Based Payment Modifier (VM) and its successor, the Merit-Based Incentive Payment System (MIPS), and the Medicare Shared Savings Program (MSSP) on these elements of program design and reviewed the literature to place findings in context...
November 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28710221/trends-in-readmission-rates-for-safety-net-hospitals-and-non-safety-net-hospitals-in-the-era-of-the-us-hospital-readmission-reduction-program-a-retrospective-time-series-analysis-using-medicare-administrative-claims-data-from-2008-to-2015
#7
Amy M Salerno, Leora I Horwitz, Ji Young Kwon, Jeph Herrin, Jacqueline N Grady, Zhenqiu Lin, Joseph S Ross, Susannah M Bernheim
OBJECTIVE: To compare trends in readmission rates among safety net and non-safety net hospitals under the US Hospital Readmission Reduction Program (HRRP). DESIGN: A retrospective time series analysis using Medicare administrative claims data from January 2008 to June 2015. SETTING: We examined 3254 US hospitals eligible for penalties under the HRRP, categorised as safety net or non-safety net hospitals based on the hospital's proportion of patients with low socioeconomic status...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28657950/national-trends-in-readmission-following-inpatient-surgery-in-the-hospital-readmissions-reduction-program-era
#8
Winta T Mehtsun, Irene Papanicolas, Jie Zheng, E John Orav, Keith D Lillemoe, Ashish K Jha
OBJECTIVE: The aim of this study was to investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a "spillover" effect on surgical conditions. SUMMARY BACKGROUND DATA: During the past decade, there have been multiple national efforts to improve surgical care. Readmission rates are a key metric for assessing surgical quality. Whether surgical readmission rates have declined, and whether the Hospital Readmissions Reduction Program has had an influence is unclear...
June 27, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28647442/the-impact-of-the-transition-from-volume-to-value-on-heart-failure-care-implications-of-novel-payment-models-and-quality-improvement-initiatives
#9
REVIEW
Dushyanth Srinivasan, Nihar R Desai
In response to wide variation in quality and outcomes as well as escalating health care costs, the U.S. health care system is moving away from a volume-based payment system to a quality- and value-based system. Medicare, the largest insurer and payer of health care, has accelerated the movement toward value-based care with the development and implementation of myriad alternate payment models and pay-for-performance programs as part of the Affordable Care Act. Given that heart failure affects a significant number of Medicare patients and that these patients account for a disproportionate amount of health care utilization and spending, heart failure has become a focal point for these initiatives...
June 21, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28480598/further-evidence-on-the-system-wide-effects-of-the-hospital-readmissions-reduction-program
#10
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
#11
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...
September 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28461357/most-hospitals-received-annual-penalties-for-excess-readmissions-but-some-fared-better-than-others
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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