Data and sample

We conducted a pooled cross-sectional analysis of US hospitals from 2009 to 2015 using merged data from CMS Hospital Compare, ¹⁵ the American Hospital Association Annual Survey Database (AHA), ¹⁶ and the Area Health Resource File (AHRF). ¹⁷ We focused on this time period in order to determine the short-term effects of the HRRP policy. Data were linked using Provider IDs and FIPS codes. In order to be included in the sample, hospitals had to have two or more of the AMI, HF, and PN readmission rates available in each year from 2009 to 2015. We excluded Veterans Health Administration hospitals because HRRP penalties do not apply to these hospitals. ¹⁸ Hospital Compare data contains risk-standardized hospital level 30-day readmission rates for patients admitted for AMI, HF, and PN. ¹⁹ AHA data was utilized to obtain hospital-level organizational characteristics. The AHRF contains variables that were used to determine market characteristics in the hospital external environment. We did not submit this research to an Institutional Review Board or Independent Ethics Committee. Ethical approval and informed consent were not sought for the present study because we utilize deidentified, publicly available data (https://www.hhs.gov/ohrp/sites/default/files/human-subject-regulations-decision-charts-2018-requirements.pdf).