Spillover Effects of the Hospital Readmissions Reduction Program on Radical Cystectomy Readmissions

Introduction: Readmission rates after radical cystectomy are among the highest of any surgery. The HRRP (Hospital Readmissions Reduction Program) penalizes hospitals with excess readmissions for certain targeted conditions, including total hip and knee arthroplasty. We examined whether changes made by hospitals in response to the HRRP had spillover effects on radical cystectomy readmissions. Methods: We used a 20% sample of Medicare data to identify patients undergoing cystectomy from 2010 to 2014 and measured 30-day adjusted cystectomy readmission rates. To determine the effect of the HRRP we calculated adjusted readmission rates following total hip or knee arthroplasty and stratified hospitals into quartiles (most improved, middle quartiles, least improved) based on their improvement in reducing those targeted readmissions. Multivariable logistic regression was used to identify factors associated with spillover effects from the targeted joint surgery to cystectomy. Results: We identified 2,394 patients undergoing radical cystectomy. Of these patients 606 were treated at hospitals in the "most improved" quartile and 522 in the "least improved" quartile. Patients undergoing cystectomy were similar in age, comorbidity and socioeconomic class independent of hospital performance quartile. The readmission rate following cystectomy was 26% in the most improved quartile and 24% in the least improved quartile. No spillover effect was identified between readmission reduction after major joint surgery and radical cystectomy (adjusted OR 0.90, p=0.42). Conclusions: Hospitals that succeeded in reducing readmissions following major joint surgery targeted by the HRRP did not have similar reductions in readmissions following radical cystectomy. This lack of spillover effect suggests that each surgical condition may require tailored interventions to prevent readmissions.