Dive Brief:
- With Medicare’s Hospital Readmissions Reduction Program (HRRP) having drawn debate as to whether it places unfair burdens on safety-net hospitals, due their low-income populations that face potentially greater challenges in avoiding readmissions, a new study published in Health Affairs takes a look at how these hospitals have fared so far under the program.
- The researchers from Boston University and Boston Medical Center found that overall between fiscal years 2013 and 2016, safety-net hospitals reduced their readmission rates even more than other hospitals because they had more room for improvement, resulting in a reduced disparity between their readmission rates and those of other hospitals.
- The report concludes that safety-net hospitals do appear to have been able to respond to HRRP incentives, but that nonetheless, they are at a disadvantage in doing so and the issue of fairness remains.
Dive Insight:
Although the progress achieved by safety-net hospitals looks good on the surface, deeper analysis reveals that when they are compared to other hospitals that also had significant room for improvement, they compared less favorably, presumably because of the increased challenges faced by their populations.
The report cites previous data indicating that a disproportionate number of patients at safety-net hospitals lack resources needed to succeed upon discharge, including social support and primary care, and suggests that with such factors being outside safety-net hospitals' control, it is unfair to hold them to the same standard for penalties.
Under the program, CMS penalizes hospitals for 30-day readmission rates that exceed national averages for other hospitals with a comparable case-mix. The case-mix adjustment includes factors such as patients’ age, sex, comorbidities, and frailty but does not factor in patients’ socioeconomic status.
The stakes are high. Recent data showing Medicare will withhold a record total of about $528 million over the next year, with more than half of all U.S. hospitals (2,497) being punished for their rehospitalization rates.
Numerous suggestions have been put forward as to how to better level the playing field for hospitals under the program. The Boston researchers say their results support the concept of evaluating safety-net hospitals against other safety-net hospitals. "This would maintain incentives for improvement but would reduce financial pressure on safety-net hospitals, especially for those with patient populations of the lowest socioeconomic status," they wrote.