A new study has found that Medicare patient readmission rates were about 17 percent higher in safety-net hospitals—those that care for a disproportionate share of low-income patients—than other hospitals in 2012. The study, which was published in Health Affairs, fuels a debate by scholars and policymakers over the impact of the federal Hospital Readmissions Reduction Program (HRRP) on safety-net hospitals. As an earlier Partnership Matters story explained, the program’s penalties for higher than average 30-day readmission rates do not take a patient’s socioeconomic status (SES) into account. Some have called for SES risk adjustment. Pointing out that lower SES has been found to be associated with likelihood of being readmitted, they say that failing to make some allowances for that increased risk unfairly penalizes safety-net hospitals.
The Health Affairs study found some evidence to support that point of view. However, the study found that patient SES explained only a quarter of the difference between safety-net hospital readmission rates and those of other hospitals. Forty percent of the disparity could not be explained by SES or other factors measured in the study, which included race, sex, age, length of stay, discharge destination, certain hospital characteristics (e.g. teaching hospital status, profit status, number of beds) and hospital county characteristics (e.g. urban vs. rural, unemployment rate etc). As a result, the study found, if safety-net hospitals had the same patient mix as other hospitals, they would still be burdened by higher readmission rates.
Further, while safety-net hospitals did face higher readmission penalties, the difference in penalty burden was just 0.03% in fiscal year 2015.
The Health Affairs study concluded that the unexplained difference in readmission rates may be partly due to hospital characteristics such as quality of care. As such, the authors argued that adding SES to the “current readmission risk-adjustment method, might be relatively ineffective at mitigating penalty differences between safety-net and other hospitals.” They suggest that the federal government wait until research further illuminates factors that account for readmission differences across hospitals before implementing policy changes.
FierceHealthcare predicts that the Health Affairs study findings will “intensify the controversy over Centers for Medicare and Medicaid (CMS) measures for readmissions penalties.”
CMS is working with the National Quality Forum as they undertake a two-year trial to test sociodemographic factor risk adjustment.
A 2013 Labor Management Project Research Bulletin summarizes the hospital readmissions program and best practices for reducing avoidable readmissions. It also provides links to useful resources.