Readmission rates are down among safety-net hospitals, but CMS needs to tweak its readmission reduction program to make it fairer to such providers, according to a new study published in Health Affairs.
CMS' Hospital Readmissions Reduction Program (HRRP) reduces reimbursements by up to 3 percent for hospitals that have higher-than-expected 30-day readmission rates among Medicare beneficiaries treated for certain conditions. Some safety-net hospitals say the program is unfair because it doesn't account for social determinants of health that may increase readmissions among their patient populations.
The study analyzed risk-adjusted 30-day readmission rates at safety-net hospitals and the rates at other hospitals between fiscal years 2013 and 2016. The researchers looked at three of the six conditions for which providers are judged under HRRP: heart attack, heart failure, and pneumonia.
Compared with the other hospitals included in the review, the study found that safety-net hospitals had greater declines in readmission rates for all three conditions.
- For heart attacks, safety-net hospitals reduced readmissions by about 2.8 percentage points, while other hospitals reduced readmissions by about 2.6 percentage points;
- For heart failures, safety-net hospitals reduced readmissions by about 2.78 percentage points, while other hospitals reduced readmissions by about 2.7 percentage points;
- For pneumonia cases, safety-net hospitals reduced readmissions by about 1.8 percentage points, while other hospitals reduced readmissions by about 1.5 percentage points.
However, the researchers noted that while safety-net hospitals saw greater improvements, they also had higher readmission rates to start with for all three conditions "and so had more room for improvement."
The researchers added, "While the fairness issue remains unresolved, it appears that safety-net hospitals have been able to respond to [HRRP's] incentives."
The researchers also addressed calls for changes to the program, noting that "policymakers should bear in mind that a penalty program may not provide the best lever for incentivizing performance improvement in safety-net hospitals." They concluded, "It would be advisable for CMS to pay attention to characteristics of hospitals that succeed in reducing readmissions as it modifies and expands the" program (Diamond, "Pulse," Politico, 9/22; Minemyer, FierceHealthcare, 9/22; Lagasse, Healthcare Finance News, 9/23; Health Affairs blog, 9/21; Carey/Lin, Health Affairs, September 2016).
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