• John A Staples, Ying Yu, Mayesha Khan, Hiten Naik, Guiping Liu, Jeffrey R Brubacher, Ahmer Karimuddin, and Jason M Sutherland.
• Department of Medicine, University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, Canada; Centre for Health Evaluation & Outcome Sciences (CHÉOS), Vancouver, Canada. Electronic address: john.staples@ubc.ca.
• Am. J. Med. 2024 Sep 1; 137 (9): 847856.e11847-856.e11.

BackgroundUnplanned hospital readmissions are associated with adverse patient outcomes and substantial healthcare costs. It remains unknown whether physician financial incentives for enhanced discharge planning can reduce readmission risk.MethodsIn 2012, policymakers in British Columbia, Canada, introduced a $75 fee-for-service physician payment to incentivize enhanced discharge planning (the "G78717" fee code). We used population-based administrative health data to compare outcomes among G78717-exposed and G78717-unexposed patients. We identified all nonelective hospitalizations potentially eligible for the incentive over a 5-year study interval. We examined the composite risk of unplanned readmission or death and total direct healthcare costs accrued within 30 days of discharge. Propensity score overlap weights and adjustment were used to account for differences between exposed and unexposed patients.ResultsA total of 5262 of 24,787 G78717-exposed and 28,096 of 136,541 unexposed patients experienced subsequent unplanned readmission or death, suggesting exposure to the G78717 incentive did not reduce the risk of adverse outcomes after discharge (crude percent, 21.1% vs 20.6%; adjusted odds ratio, 0.97; 95% CI, 0.93-1.01; P = .23). Mean direct healthcare costs within 30 days of discharge were $3082 and $2993, respectively (adjusted cost ratio, 1.00; 95% CI, 0.95-1.05; P = .93).ConclusionsA physician financial incentive that encouraged enhanced hospital discharge planning did not reduced the risk of readmission or death, and did not significantly decrease direct healthcare costs. Policymakers should consider the baseline prevalence and effectiveness of enhanced discharge planning, the magnitude and design of financial incentives, and whether auditing of incentivized activities is required when implementing similar incentives elsewhere.Trial RegistrationClinicalTrials.gov ID, NCT03256734.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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