title: Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals.
abstract: OBJECTIVE
  To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals.
  
  
  BACKGROUND
  The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown.
  
  
  METHODS
  We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N = 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non-minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles.
  
  
  RESULTS
  Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non-minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million).
  
  
  CONCLUSIONS
  Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.
authors.affiliation: *Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI †Division of Outcomes and Effectiveness Research, Department of Public Health, Weill Cornell Medical College, New York, NY.
authors.forename: Terry
authors.initials: T
authors.lastname: Shih
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Ryan
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Gonzalez
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D017721:Hospital Costs; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D008913:Minority Groups / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology