The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations. (13th January 2014)

• Record Type: Journal Article
• Authors: Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P.
• Is Part Of: Health services research. Volume 49:Number 3(2014)
• Page Start: 818
• Page End: 837
• Publication Date: 2014-01-13
• Subjects: Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12150
• Languages: English
• ISSNs: 0017-9124

Abstract

<abstract abstract-type="main" id="hesr12150-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hesr12150-sec-0001" sec-type="section"> <title>Objective</title> <p>To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations.</p> </sec> <sec id="hesr12150-sec-0002" sec-type="section"> <title>Data Sources/Study Setting</title> <p>Medicare inpatient claims to calculate condition‐specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics.</p> </sec> <sec id="hesr12150-sec-0003" sec-type="section"> <title>Study Design</title> <p>Regression analyses and projections were used to estimate risk‐adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP.</p> </sec> <sec id="hesr12150-sec-0004" sec-type="section"> <title>Principal Findings</title> <p>Both patient dual‐eligible status and a hospital's dual‐eligible share of Medicare discharges have a positive impact on risk‐adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high‐dual hospitals are more likely to have excess readmissions than low‐dual hospitals. As a result, HRRP penalties will disproportionately fall on high‐dual hospitals, which are more likely to have negative all‐payer margins, raising concerns of unintended consequences of the program for vulnerable populations.</p> </sec> <sec id="hesr12150-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations.</p> </sec> </abstract>