Safety-Net Hospitals Show Improvement in Hospital Readmissions, Modifications To Penalty Formula Still Needed Interview with:

Kathleen Carey, Ph.D. Professor, Department of Health Law, Policy and Management School of Public Health Boston University Boston MA  02118

Dr. Kathleen Carey

Kathleen Carey, Ph.D.
Professor, Department of Health Law, Policy and Management
School of Public Health
Boston University
Boston MA What is the background for this study? What are the main findings?
Response: The ACA’s Hospital Readmissions Reduction Program (HRRP) imposes Medicare reimbursement penalties on hospitals with readmission rates for certain conditions if they exceed national averages. A number of observers have expressed serious concern over the program’s impact on safety-net hospitals, which serve a high proportion of low income patients who are more likely to be readmitted – often for reasons outside hospital control. Many have argued that the HRRP should adjust for socio-economic status. However, Medicare does not want to lower the standard of quality for these hospitals.

This study broadened perspective on the issue by addressing the question of whether the HRRP has been an effective policy for reducing readmissions in safety-net hospitals. We found that in the first three years of the program, safety-net hospitals reduced readmissions for heart attacks by 2.86 percentage points, for heart failure by 2.78 percentage points, and for pneumonia by 1.77 percentage points. These improvements, between 2013 and 2016, were greater than those achieved in other hospitals. But we also found that when compared with other hospitals that had high readmission rates to begin with, safety-net hospitals had smaller readmission reductions. What should readers take away from your report?

Response: That safety-net hospitals have achieved greater readmission reduction than other hospitals shows that the disparity in readmissions rates and ensuing penalties have been reduced under the ACA. This is a positive policy outcome. Yet safety-net hospitals had smaller reductions than other hospitals who also had high readmission rates, which may reflect the unique difficulties faced by safety-net hospitals in controlling readmissions. What recommendations do you have for future research as a result of this study?

Response: Both the Medicare Payment Advisory Commission (MedPAC) and the Helping Hospitals Improve Patient Care Act of 2016 (H.R.5273), passed in the House, have recommended modification of the HRRP such that safety-net hospitals be evaluated against their peers. The results of our study support these recommendations as a way regulating safety-net hospitals in a manner that would level the playing field and hence relieve financial pressure, while maintaining incentives for performance improvement. Thank you for your contribution to the community.


Hospital Readmissions Reduction Program: Safety-Net Hospitals Show Improvement, Modifications To Penalty Formula Still Needed
Kathleen Carey and Meng-Yun Lin

Health Aff 10.1377/hlthaff.2016.0537; published ahead of print September 21, 2016, doi:10.1377/hlthaff.2016.0537

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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