Journal of General Internal Medicine

, Volume 34, Issue 4, pp 515–517 | Cite as

Against Medical Advice Discharges Are Increasing for Targeted Conditions of the Medicare Hospital Readmissions Reduction Program

  • Eberechukwu Onukwugha
  • David AlfandreEmail author
Concise Research Reports


The Medicare Hospital Readmissions Reduction Program (HRRP), established with the Affordable Care Act, began reducing payments in 2012 to Medicare-participating hospitals with higher than expected readmission rates for the targeted conditions of heart failure (HF), acute myocardial infarction (AMI), and pneumonia (PN). The readmission ratio calculations were adjusted for clinically relevant factors1 and by excluding admissions ending in an against medical advice (AMA) discharge, when a patient leaves the hospital prior to a physician-recommended endpoint. Although the HRRP has reduced readmissions overall,2 there remains the possibility of unintended negative consequences. Given that an AMA discharge designation under the HRRP may have positive financial implications for the hospital, we sought to identify if the HRRP was associated with a change in AMA discharges.


We utilized longitudinal data from the National Inpatient Sample (NIS) available through HCUPnet3...


health policy against medical advice discharge readmission 


Compliance with Ethical Standards


The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the US Department of Veterans Affairs or the VA National Center for Ethics in Health Care.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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    Centers for Medicare & Medicaid Services - Readmissions Reduction Program (HRRP). Accessed October 3, 2018.
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    HCUPnet, Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality, Rockville, MD. Accessed October 3, 2018.
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Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  1. 1.Department of Pharmaceutical Health Services ResearchUniversity of Maryland School of PharmacyBaltimoreUSA
  2. 2.VA National Center for Ethics in Health Care, US Department of Veterans AffairsNYU School of MedicineNew YorkUSA

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