title: Accounting For Patients' Socioeconomic Status Does Not Change Hospital Readmission Rates.
abstract: There is an active public debate about whether patients' socioeconomic status should be included in the readmission measures used to determine penalties in Medicare's Hospital Readmissions Reduction Program (HRRP). Using the current Centers for Medicare and Medicaid Services methodology, we compared risk-standardized readmission rates for hospitals caring for high and low proportions of patients of low socioeconomic status (as defined by their Medicaid status or neighborhood income). We then calculated risk-standardized readmission rates after additionally adjusting for patients' socioeconomic status. Our results demonstrate that hospitals caring for large proportions of patients of low socioeconomic status have readmission rates similar to those of other hospitals. Moreover, readmission rates calculated with and without adjustment for patients' socioeconomic status are highly correlated. Readmission rates of hospitals caring for patients of low socioeconomic status changed by approximately 0.1 percent with adjustment for patients' socioeconomic status, and only 3-4 percent fewer such hospitals reached the threshold for payment penalty in Medicare's HRRP. Overall, adjustment for socioeconomic status does not change hospital results in meaningful ways.
authors: Susannah M. Bernheim (susannah.bernheim@yale.edu) is director of quality measurement at the Center for Outcomes Research and Evaluation (CORE) at Yale-New Haven Hospital and an assistant clinical professor in the Department of Internal Medicine at Yale School of Medicine, both in New Haven, Connecticut.
authors: Susannah M
authors: SM
authors: Bernheim
authors: Craig S. Parzynski is a senior statistician at CORE, Yale-New Haven Hospital.
authors: Craig S
authors: CS
authors: Parzynski
authors: Leora Horwitz is an associate professor of internal medicine, population health, at New York University School of Medicine, in New York City.
authors: Leora
authors: L
authors: Horwitz
authors: Zhenqiu Lin is director of analytics at CORE, Yale-New Haven Hospital.
authors: Zhenqiu
authors: Z
authors: Lin
authors: Michael J. Araas is research project manager at CORE, Yale-New Haven Hospital.
authors: Michael J
authors: MJ
authors: Araas
authors: Joseph S. Ross is an associate professor of medicine in the Department of Internal Medicine at Yale School of Medicine.
authors: Joseph S
authors: JS
authors: Ross
authors: Elizabeth E. Drye is a director of quality measurement at CORE, Yale-New Haven Hospital.
authors: Elizabeth E
authors: EE
authors: Drye
authors: Lisa G. Suter is associate director of quality measurement at CORE, Yale-New Haven Hospital, and an associate professor of medicine in the Section of Rheumatology at Yale School of Medicine.
authors: Lisa G
authors: LG
authors: Suter
authors: Sharon-Lise T. Normand is a professor of health care policy and biostatistics at Harvard Medical School and at the Harvard T. H. Chan School of Public Health, both in Boston, Massachusetts.
authors: Sharon-Lise T
authors: SL
authors: Normand
authors: Harlan M. Krumholz is the Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at Yale School of Medicine.
authors: Harlan M
authors: HM
authors: Krumholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics*; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures; D006780:Hospitals, Rural / Q000191:economics; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States
keywords: Disparities; Quality Of Care; Safety-Net Systems