CMS hospital readmission reduction program and anticoagulants received following a total hip and knee arthroplasty discharge

Abstract

Objectives: To assess association between 30 day readmission rate and treatment received after total hip and knee arthroplasty (THA/TKA) discharge (rivaroxaban vs. warfarin or non-anticoagulant). To subsequently model impact of increasing rivaroxaban use on the Hospital Readmission Reduction Program (HRRP) penalty, which was imposed on hospitals with excess 30 day readmissions after hospitalizations for selected conditions, including THA/TKA.

Methods: The US Truven Health MarketScan Medicare Supplemental database from 1 July 2010 to 30 April 2015 was used. A retrospective claims analysis was conducted to assess the risk of all-cause 30 day readmission among patients receiving either rivaroxaban or warfarin, or no anticoagulation following THA/TKA discharge. Simulations were performed to estimate the impact of post-discharge treatment on the HRRP penalty.

Results: The risk-adjusted all-cause 30 day readmission rates were 1.21% (95% confidence interval [95% CI]: 0.94%–1.49%), 1.41% (95% CI: 1.19%–1.58%) and 1.95% (95% CI: 1.81%–2.11%) for rivaroxaban, warfarin and non-anticoagulant cohorts, respectively. Using these rates, simulations illustrated that when switching patients from warfarin or non-anticoagulant to rivaroxaban, annual penalty per hospital would be reduced up to 67% or 88%, respectively.

Conclusions: Rivaroxaban treatment post-THA/TKA discharge reduced the risk of 30 day readmission compared to non-anticoagulants. Simulations illustrated that increasing rivaroxaban use could decrease the HRRP penalty.

Keywords:

• Rivaroxaban
• warfarin
• patient readmission
• penalty
• arthroplasty
• Medicare

Transparency

Declaration of funding

This research was funded by Janssen Scientific Affairs LLC.

Declaration of financial/other relationships

B.B. and J.S. have disclosed that they are employees of Janssen Scientific Affairs LLC and Johnson & Johnson. C.I.C. has disclosed that he is a Professor at the University of Connecticut School of Pharmacy. S.M. has disclosed that he is an employee of Johnson & Johnson. S.K. has disclosed that he is a hospitalist at Henry Ford Hospital. F.L., W.W., Y.X. and P.L. have disclosed that they are employees of Analysis Group Inc., a consulting company that has received research funds from Janssen Scientific Affairs LLC.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

None reported.