Is the Hospital Value-Based Purchasing Program Associated with Reduced Hospital Readmissions?

Figures & data

Table 1 Overall Descriptive Statistics

	Mean	s.d.
All Cause Hospital-Wide Readmission Rate	15.56%	0.96%
Hip/Knee Readmission Rate	4.01%	0.53%
COPD Readmission Rate	19.67%	1.10%
Heart Attack Readmission Rate	16.11%	1.05%
Heart Failure Readmission Rate	21.96%	1.64%
Pneumonia Readmission Rate	16.74%	1.24%
HVBP Eligible Hospitals	0.83	0.38
For-Profit Ownership (1 = For Profit)	0.24	0.43
# of Staffed Beds	189.30	186.82
Teaching (1 = Teaching)	0.05	0.23
Case Mix Index (CMI)	1.63	0.37
Average Length of Stay	4.48	4.66
Outpatient Service Mix	54.74%	20.01%
Urban/Rural (1 = Urban)	0.69	0.46
Government (1 = Government Operated)	0.15	0.35
# of Discharges	9570	10,739.84
System Member (1 = System Member)	0.81	0.39
Market Concentration HHI	0.34	0.32
Occupancy Rate	48.84%	20.51%
Hospital Compare (1 = Score = 5; 0 = Score < 5)	0.11	0.31
Region 1 (CT, ME, MA, NH, RI, VT)	0.04	0.19
Region 2 (NJ, NY, PA)	0.11	0.31
Region 3 (DE, KY, MD, NC, VA, WV, DC)	0.09	0.28
Region 4 (AL, FL, GA, MS, SC, TN, PR)	0.17	0.37
Region 5 (IL, MI, IN, OH, WI)	0.15	0.36
Region 6 (IA, KS, MN, MO, NE, ND, SD)	0.08	0.0.27
Region 7 (AR, LA, OK, TX)	0.15	0.36
Region 8 (AZ, CO, ID, MT, NM, UT, WY)	0.07	0.24
Region 9 (AK, CA, HI, NV, OR, WA)	0.13	0.33

Note: N = 3276 short-term acute care hospitals.

Table 2 Comparative Descriptive Statistics

	HVBP Hospitals (n = 2719)		Non-HVBP Hospitals (n = 557)
	Mean	s.d.	Mean	s.d.
All Cause Readmission Rate	15.60%	0.95%	15.34%	1.05%
Hip/Knee Readmission Rate	4.03%	0.53%	3.81%	0.49%
COPD Readmission Rate	19.68%	1.12%	19.46%	0.84%
Heart Attack Readmission Rate	16.12%	1.05%	15.95%	1.09%
Heart Failure Readmission Rate	21.96%	1.66%	21.99%	1.29%
Pneumonia Readmission Rate	16.74%	1.26%	16.67%	0.99%
For-Profit Ownership	0.21	0.41	0.40	0.49
# of Staffed Beds	212.57	190.86	74.23	107.10
Teaching	0.06	0.24	0.02	0.15
Case Mix Index (CMI)	1.63	0.29	1.62	0.66
Average Length of Stay	4.31	0.95	5.35	11.27
Outpatient Service Mix	55.10%	17.33%	53.04%	29.55%
Urban/Rural	0.68	0.47	0.74	0.44
Government	0.13	0.34	0.20	0.40
# of Discharges	10,841	11,050.30	3119	5590.20
System Member	0.84	0.36	0.65	0.48
Market Concentration HHI	0.35	0.33	0.28	0.28
Occupancy Rate	51.69%	18.42%	34.35%	24.18%
Hospital Compare	0.12	0.33	0.03	0.18
Region 1 (CT, ME, MA, NH, RI, VT)	0.04	0.20	0.01	0.12
Region 2 (NJ, NY, PA)	0.12	0.32	0.08	0.27
Region 3 (DE, KY, MD, NC, VA, WV, DC)	0.09	0.28	0.12	0.32
Region 4 (AL, FL, GA, MS, SC, TN, PR)	0.17	0.38	0.14	0.34
Region 5 (IL, MI, IN, OH, WI)	0.16	0.37	0.08	0.28
Region 6 (IA, KS, MN, MO, NE, ND, SD)	0.08	0.27	0.07	0.26
Region 7 (AR, LA, OK, TX)	0.13	0.34	0.27	0.44
Region 8 (AZ, CO, ID, MT, NM, UT, WY)	0.06	0.24	0.08	0.26
Region 9 (AK, CA, HI, NV, OR, WA)	0.14	0.35	0.06	0.24

Note: N = 3276 hospitals total.

Table 3 Multiple Regression of All Readmission Rate Dependent Variables

Variable	All Cause Readmission Rate			Hip/Knee Readmission Rate			Chronic Obstructive Pulmonary Disease Readmission Rate			Heart Attack Readmission Rate				Heart Failure Readmission Rate			Pneumonia Readmission Rate
	β	S.E.	Sig	β	S.E.	Sig	β	S.E.	Sig	β	S.E.	Sig		β	S.E.	Sig	β	S.E.	Sig
	N = 2841, Adj R^2 = 24.7%			N = 2285, Adj R^2 = 12.3%			N = 2541, Adj R^2 = 10.0%			N = 1937, Adj R2 = 13.7%				N = 2586, Adj R^2 = 18.3%			N = 2615, Adj R^2 = 16.0%
HVBP Eligible	0.369	0.048	<0.001	0.223	0.032	<0.001	0.264	0.064	<0.001	0.254	0.069		<0.001	0.279	0.09	0.002	0.190	0.068	0.005
For Profit Ownership	0.401	0.042	<0.001	0.165	0.028	<0.001	0.291	0.056	<0.001	0.406	0.060		<0.001	0.000	0.078	<0.001	0.548	0.06	<0.001
# of Staffed Beds	0.001	0.000	0.003	0.000	0.000	0.069	0.000	0.000	0.280	0.000	0.000		0.362	0.000	0.000	0.853	0.000	0.000	0.354
Teaching	0.358	0.081	<0.001	0.015	0.053	0.773	−0.270	0.107	0.012	0.439	0.114		<0.001	0.359	0.15	0.017	0.201	0.114	0.079
Case Mix Index (CMI)	−0.598	0.052	<0.001	−0.283	0.034	<0.001	−0.181	0.069	0.009	−0.433	0.074		<0.001	−0.885	0.097	<0.001	−0.163	0.074	0.027
Average Length of Stay	0.026	0.004	<0.001	0.007	0.002	0.002	0.018	0.005	<0.001	0.014	0.005		0.006	0.008	0.007	0.192	0.029	0.005	<0.001
Outpatient Service Mix	−0.003	0.001	0.007	−0.001	0.001	0.305	−0.004	0.001	0.002	−0.004	0.001		0.002	−0.008	0.002	<0.001	−0.006	0.001	<0.001
Urban/Rural	−0.071	0.043	0.100	0.098	0.028	<0.001	−0.050	0.057	0.386	−0.184	0.061		0.003	−0.130	0.080	0.106	−0.115	0.061	0.06
Government Operated	0.083	0.05	0.101	0.028	0.033	0.394	−0.008	0.067	0.899	−0.151	0.071		0.035	0.137	0.094	0.144	0.035	0.071	0.618
# of Discharges	0.000	0.000	0.194	0.000	0.000	0.097	0.000	0.000	0.985	0.000	0.000		0.093	0.000	0.000	0.582	0.000	0.000	0.945
System Member	−0.064	0.044	0.142	0.051	0.029	0.076	−0.003	0.058	0.963	−0.05	0.062		0.416	0.062	0.081	0.444	−0.064	0.062	0.298
Market Concentration	−0.424	0.064	<0.001	−0.077	0.042	0.067	−0.342	0.085	<0.001	−0.559	0.091		<0.001	−0.462	0.119	<0.001	−0.455	0.091	<0.001
Occupancy Rate	0.003	0.001	0.024	0.001	0.001	0.053	0.001	0.002	0.739	0.001	0.002		0.377	0.003	0.002	0.121	0.003	0.002	0.085
Hospital Compare Rating	−0.748	0.052	<0.001	−0.300	0.034	<0.001	−0.542	0.069	<0.001	−0.584	0.074		<0.001	−1.106	0.097	<0.001	−0.733	0.074	<0.001
Region 2	−0.221	0.085	0.007	−0.081	0.054	0.132	−0.014	0.108	0.895	0.142	0.116		0.221	−0.164	0.152	0.281	0.188	0.116	0.105
Region 3	−0.376	0.079	<0.001	−0.039	0.056	0.490	−0.283	0.113	0.012	−0.034	0.121		0.778	−0.482	0.158	0.002	−0.122	0.121	0.313
Region 4	−0.376	0.08	<0.001	0.024	0.052	0.640	−0.335	0.104	<0.001	0.144	0.112		0.198	−0.269	0.147	0.066	−0.125	0.112	0.263
Region 5	−0.34	0.08	<0.001	0.003	0.052	0.956	0.287	0.106	0.007	0.116	0.113		0.304	−0.362	0.148	0.015	−0.111	0.113	0.325
Region 6	−0.542	0.09	<0.001	−0.007	0.059	0.907	−0.379	0.119	<0.001	−0.064	0.127		0.615	−0.691	0.167	<0.001	−0.159	0.127	0.212
Region 7	−0.404	0.081	<0.001	0.054	0.053	0.303	−0.386	0.106	<0.001	0.224	0.114		0.049	−0.268	0.15	0.074	−0.284	0.114	0.013
Region 8	−0.787	0.094	<0.001	−0.062	0.062	0.315	−0.786	0.124	<0.001	−0.330	0.133		0.013	−1.357	0.174	<0.001	−0.833	0.133	<0.001
Region 9	−0.655	0.083	<0.001	−0.157	0.054	0.004	−0.529	0.11	<0.001	0.011	0.117		0.925	−0.498	0.154	0.001	−0.320	0.117	0.006

Notes: α =0.05; Region 1 is referent region for analysis purposes.