title: Understanding Medicare Hospital Readmission Rates And Differing Penalties Between Safety-Net And Other Hospitals.
abstract: Since the implementation of Medicare's Hospital Readmissions Reduction Program in 2012, concerns have been raised about the effect its payment penalties for excess readmissions may have on safety-net hospitals. A number of policy solutions have been proposed to ensure that the program does not unfairly penalize safety-net institutions, which treat a disproportionate number of patients with low socioeconomic status. We examined the extent to which the program's current risk-adjustment factors, measures of patient socioeconomic status, and hospital-level factors explain the observed differences in readmission rates between safety-net and other hospitals. Our analyses suggest that patient socioeconomic status can explain some of the difference in readmission rates but that unmeasured factors such as hospitals' performance may also play a role. We also found that safety-net hospitals have experienced only slightly higher readmission penalties under the program than other hospitals have. Together, these findings suggest the need for a careful evaluation of policy alternatives that factor socioeconomic status into penalty calculations for excess readmissions to determine whether such alternatives could have a significant impact on penalties while remaining consistent with overall objectives for delivery system transformation.
authors.affiliation: Steven H. Sheingold (steven.sheingold@hhs.gov) is director of the Division of Health Financing Policy in the Department of Health and Human Services, in Washington, D.C.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Sheingold
authors.affiliation: Rachael Zuckerman is an economist in the Department of Health and Human Services.
authors.forename: Rachael
authors.initials: R
authors.lastname: Zuckerman
authors.affiliation: Adele Shartzer is a research associate in the Health Policy Center at the Urban Institute, in Washington, D.C.
authors.forename: Adele
authors.initials: A
authors.lastname: Shartzer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018166:Health Care Reform; D019538:Health Care Surveys; D006761:Hospitals; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D064876:Safety-net Providers / Q000191:economics*; D012737:Sex Factors; D017664:Uncompensated Care / Q000191:economics; D014481:United States
keywords: Health Reform; Hospitals; Quality Of Care