Study Finds Coding Policy Changes Give Appearance of Reduced Hospital Readmission Rates

A coding policy change allowing more than 10 diagnosis codes to be submitted on a claim reduced hospital 30-day readmission rates for targeted conditions, according to a new study published in Health Affairs. However, because the coding policy happened at the same time as a change in electronic transmission standards went into effect, the readmission improvements look to be illusory and overstated, researchers found.

Medicare’s Hospital Readmissions Reduction Program (HRRP), which permitted the use of additional diagnosis codes, impacted hospitals’ risk adjustment scores, resulting in the appearance of lower readmission rates.

“Accounting for the revised standards reduced the decline in risk-adjusted readmission rates for targeted conditions by 48 percent. After further adjusting for differences in pre-HRRP readmission rates across samples, we found that declines for targeted conditions at general acute care hospitals were statistically indistinguishable from declines in two control samples,” the study authors wrote. “Either the HRRP had no effect on readmissions, or it led to a systemwide reduction in readmissions that was roughly half as large as prior estimates have suggested.”

A study published in the Journal of the American Medical Association (JAMA) a year ago noted a 63 percent reduction in readmission rates in the HRRP program, related to coding severity.

“Even though these are different methods, the punchline is still the same. At best the hospital readmissions program reduced readmissions in maybe half the magnitude we think,” JAMA lead author, Dr. Andrew Ibrahim, told Modern Healthcare.

Mary Butler is the associate editor at Journal of AHIMA.

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