Reliability of 30-Day Readmission Measures Used in the Hospital Readmission Reduction Program

Michael P. Thompson, Cameron M. Kaplan, Yu Cao, Gloria J. Bazzoli, Teresa M. Waters

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


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. We used publicly available data to estimate payments for excess readmissions in hospitals with reliable and unreliable RSRRs. Principal Findings: Only RSRRs for surgical procedures exceeded the reliability benchmark for most hospitals, whereas RSRRs for medical conditions were typically below the benchmark. Additional adjustment for socioeconomic and hospital factors modestly explained variation in RSRRs. Approximately 25 percent of payments for excess readmissions were tied to unreliable RSRRs. Conclusions: Many of the RSRRs employed by the HRRP are unreliable, and one quarter of payments for excess readmissions are associated with unreliable RSRRs. Unreliable measures blur the connection between hospital performance and incentives, and threaten the success of the HRRP.

Original languageEnglish
Pages (from-to)2095-2114
Number of pages20
JournalHealth Services Research
Issue number6
StatePublished - Dec 1 2016

Bibliographical note

Publisher Copyright:
© Health Research and Educational Trust


  • Readmissions
  • reliability
  • risk-adjustment

ASJC Scopus subject areas

  • Health Policy


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