Karen Joynt Maddox, MD, MPHAssistant Professor of MedicineWashington University Brown School of Social Work

Changes in Medicare’s Hospital Readmissions Reduction Program Affect Poor and Low Poverty Hospitals Differently

MedicalResearch.com Interview with:

Karen Joynt Maddox, MD, MPHAssistant Professor of MedicineWashington University Brown School of Social Work

Dr. Joynt Maddox

Karen Joynt Maddox, MD, MPH
Assistant Professor of Medicine
Washington University Brown School of Social Work 

MedicalResearch.com: What is the background for this study?

Response: Medicare’s Hospital Readmissions Reduction Program has been controversial, in part because until 2019 it did not take social risk into account when judging hospitals’ performance. In the 21st Century Cures Act, Congress required that CMS change the program to judge hospitals only against other hospitals in their “peer group” based on the proportion of their patients who are poor. As a result, starting with fiscal year 2019, the HRRP divides hospitals into five peer groups and then assesses performance and assigns penalties. 

MedicalResearch.com: What are the main findings?

Response: We wanted to see what the likely impact of this change would be on hospitals around the country. Using 2018 hospitals payments as a starting point, we found that under the new rules, penalty dollars will shift significantly. For example, hospitals in the highest-poverty group (generally referred to as the safety net) were projected to have a decrease in penalties of over 22 million dollars, while hospitals in the lowest-poverty group were projected to have an increase of over $12 million. Teaching hospitals and large hospitals, as well as hospitals located in states with more generous Medicaid eligibility cutoffs, were the most likely to see their penalties drop under stratification.

MedicalResearch.com: What should readers take away from your report?

Response: The new change to the Medicare’s Hospital Readmissions Reduction Program is going to change hospitals’ penalties in 2019 a great deal. We think this is a fairer way to assess hospitals’ performance. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future studies should follow readmission rates and penalties in future years as the program continues to evolve. Future research should also examine disparities in readmission rates related to social risk factors, with a particular focus on finding interventions that work for vulnerable populations such as individuals living in poverty. 

MedicalResearch.com: Is there anything else you would like to add?

Response: Nothing else to add, though happy to answer any follow-up questions. I do contract work for the United States Department of Health and Human Services, though this work was not funded by that contract.


Joynt Maddox KE, Reidhead M, Qi AC, Nerenz DR. Association of Stratification by Dual Enrollment Status With Financial Penalties in the Hospital Readmissions Reduction Program. JAMA Intern Med. Published online April 15, 2019. doi:10.1001/jamainternmed.2019.0117

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Last Updated on April 16, 2019 by Marie Benz MD FAAD