Heart Failure Is a Major Contributor to Hospital Readmission Penalties

•Hospitals are under financial incentives to reduce readmissions.•The contribution of heart failure to readmissions relative to acute myocardial infarction and pneumonia is not known.•Of 2,228 hospitals with ≥25 cases per disease, 1,636 (73.4%) received a penalty.•The number of cases was not related to the penalty or its magnitude.•Heart failure cases had the strongest relationship to penalty magnitude.

BackgroundThe Hospital Readmissions Reduction Program provides incentives to hospitals to reduce early readmissions for heart failure (HF), acute myocardial infarction (AMI), and pneumonia (PNE).Methods and ResultsTo examine the contribution of each diagnosis to readmissions penalty size, data were obtained from the Center for Medicare and Medicaid Services, American Hospital Association, and United States Census Bureau including number of cases; readmissions payment adjustment factor (values <1 indicate a penalty for excess readmissions), excess readmission ratio (ERR, or ratio of adjusted predicted readmission based on comorbidities, frailty, and individual patient demographics to expected probability of readmission at an average hospital) for each diagnosis, hospital teaching status, bed number, and zip code socioeconomic status. Of 2,228 hospitals with ≥25 cases per diagnosis, 1,636 received a penalty. Univariate correlation coefficients between penalty and ERR were −0.66, −0.61, and −0.43 for HF, PNE, and AMI, respectively (all P < .001). Correlation between ERRs was greatest for PNE and HF (0.30; P < .001) and weakest for PNE and AMI (0.12; P < .001). In regression analyses, the HF ERR explained the most variance in the penalty (R2 range 0.21–0.44).ConclusionHF ERR, not the number of cases, was related to penalty magnitude. These findings have implications for the design of hospital-based quality initiatives regarding readmissions.