Hospital Gaming to Avoid Penalties
The Hospital Readmission Reduction Program (HRRP), a Medicare value-based purchasing program, was established in 2012 to reduce the number of hospital readmissions by improving the quality of health care. This would not only improve patient health care, but also save each person’s tax dollars by reducing excess readmissions. Excess readmission ratios are used to measure hospital performance for six specific diseases: Heart Failure (HF), Acute Myocardial Infarction (AMI), Chronic Obstructive Pulmonary Disease (COPD), Pneumonia, Coronary Artery Bypass Graft (CABG) Surgery, and Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA). For the past year, my research team and I have been analyzing data to determine if this program is effective or if hospitals are manipulating their coding to avoid reductions in their Medicare payments from excess readmissions.This summer I assisted with the analysis of several years of hospital data across many states using Stata statistical software to determine if HRRP is effective or if hospitals are manipulating their coding to avoid reductions in Medicare payments due to excess readmissions. If we find evidence that gaming occurs, we would like to do further research to discover if the incentive for gaming is at the physician level or the organization as a whole. In the future, we hope to use our findings to better guide future healthcare policies to be more effective.