Hospitals press Congress to change readmissions program by year's end

Congress is considering legislation to account for social factors

Hospital industry officials are pressing Congress to pass legislation before the end of the year that would require CMS to account for patients' socioeconomic status in its readmission penalty program, Modern Healthcare reports.

The House earlier this year unanimously passed such a bill, but similar legislation in the Senate has yet to advance.

Background on CMS' readmissions reduction program

Under the Hospital Readmissions Reduction Program (HRRP), CMS withholds up to 3 percent of regular reimbursements for hospitals if they have a higher-than-expected number of readmissions within 30 days of discharge for six conditions: chronic lung disease; coronary artery bypass graft surgery; heart attacks; heart failure; hip and knee replacements; and pneumonia.

Currently, CMS adjust hospitals' readmissions data for certain patient demographic factors, including age, gender, past medical history, and comorbidities when they arrived at the hospital.

However, some stakeholders say HRRP penalizes hospitals based more on the kind of patients they see than the quality of care they provide. Beth Feldpush, SVP of policy and advocacy at America's Essential Hospitals (AEH), said HRRP "disproportionately penalize[s] hospitals that serve disadvantaged patients and communities."

Push for legislation

AEH, which represents 275 safety-net hospitals across the United States, has launched a campaign advocating for legislation that would require CMS to adjust the HRRP adjust the data to account for patients' socioeconomic status.

Shawn Gremminger, director of legislative affairs at AEH, said the group supports the purpose of HRRP but not its "one-size-fits-all approach." He added, "The initiative has had the unfortunate, unintended consequence of taking money from hospitals that are treating the most low-income patients."

Erik Rasmussen VP of legislative affairs at the American Hospital Association (AHA), said AHA sees legislation to change HRRP to account for patient socioeconomic status as "a high priority for the year-end session of Congress."

Still, Len Marquez, director of government relations for the Association of American Medical Colleges, said whether such legislation advances could depend on how long Congress is in session.

According to Modern Healthcare, lawmakers are waiting for an HHS report on how to best incorporate socioeconomic status into readmissions data. Blair Childs, senior VP of public affairs at Premier, said lawmakers likely will not act on the legislation until they see that report. However, Childs said the report could be released any day and hopefully will be released before Congress adjourns for the year.

Related study finds readmissions penalties disadvantage minority-serving hospitals

In related news, health disparities largely account for the difference in readmission rates between minority-serving hospitals and other hospitals, according to a study recently published in the journal Surgery.

For the study, researchers from MedStar Georgetown University Hospital analyzed data on more than 168,000 patients who underwent colorectal surgery at 374 California hospitals between 2004 and 2011 to determine associations between a hospital's status as a minority-serving provider and 30-day, 90-day, and repeat readmissions.

Forty-seven of the hospitals were considered minority-serving hospitals, at which Hispanic and black patients account for about 63 percent of the patient population. At non-minority-serving hospitals, Hispanic and black patients typically account for about 17 percent of the patient population, according to MedPage Today.

Study findings

When accounting for patients' ages, comorbidities, genders, and procedure year and type, the researchers found that, overall, the hospitals had:

  • 90-day readmission rates of 17.4 percent;
  • 30-day readmission rates of 11.6 percent; and
  • Repeated readmission rates of 3 percent.

When looking at just minority-serving hospitals, the study found those rates increased:

  • 90-day readmission rates of 20.1 percent;
  • 30-day readmission rates of 13.6 percent; and
  • Repeated readmission rates of 4 percent.

Inpatient mortality rates also were higher at minority-serving hospitals, at 4.9 percent, compared with 3.8 percent at other hospitals, the study found.

According to the researchers, patient factors—such as income levels, insurance status, and race—accounted for up to 65 percent of the increased likelihood of readmission at minority-serving hospitals. Hospital factors, such as procedure volume and type, accounted for up to 40 percent of the increase.

Senior researcher Waddah Al-Refaie, surgeon-in-chief at Georgetown Lombardi Comprehensive Cancer Center and chief of surgical oncology at Georgetown University Hospital, in a statement said, "If these factors are not balanced out, we fear minority-serving hospitals will face substantial, crippling financial penalties, and may end up being selective about the patients they admit." He added, "These findings suggest that CMS should account for patient socioeconomic factors when they compare readmission rates" (HealthLeaders Media/MedPage Today, 11/13; Dickson, Modern Healthcare, 11/14).

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