Blog » Medicare Program Reduces Readmissions, but is it Fair?

Medicare Program Reduces Readmissions, but is it Fair?

Created Nov 24 2016, 07:00 PM by Lippincott Solutions
  • Readmission Rates
  • Center for Medicare & Medicaid Services
  • Hospital Readmissions Reduction Program
  • ACA
  • safety-net hospitals
  • Affordable Care Act
  • CMS
  • HRRP

Friday, November 25, 2016

Avoidable 30-day hospital readmission rates are down nationwide following the launch of Medicare’s Hospital Readmissions Reduction Program (HRRP) more than 4 years ago. Data released in September by the Centers for Medicare & Medicaid Services shows that every state in the country except Vermont has reduced readmission rates since 2010. Hardly a problem child, Vermont’s rates are a mere tenth of a percent higher than they were pre-HRRP: 15.4% in 2015 compared with 15.3% in 2010. CMS dismissed the difference as “virtually unchanged.”   

Meanwhile, in 43 other states, readmission rates decreased more than 5%, according to CMS. In 11 states, rates dropped more than 10%.

The news comes as a welcome confirmation to officials that HRRP, created under the Affordable Care Act, is achieving its aim.

Or, as the CMS blog put it, “The data show that these efforts are working.”


But is a program that cuts Medicare payments to hospitals with high readmission rates fair to facilities treating primarily low-income populations more prone to readmission? Critics have complained for years that such safety-net hospitals are unequally burdened by HRRP penalties compared to hospitals with wealthier patients who have more resources to support their health post-discharge and avoid readmissions.

A study in the October issue of Health Affairs looked at the issue through this lens: Have safety-net hospitals been able to reduce 30-day readmissions under HRRP? To find out, researchers examined data from the first 3 years of the program.

According to the findings, safety-net hospitals have had success. In fact, safety-net hospitals achieved greater improvements than other hospitals.

In doing so, “they also reduced the disparity between their readmission rates and those of other hospitals,” wrote researchers Kathleen Carey, a professor of health law, policy, and management at Boston University, and Meng-Yun Lin, a research data analyst at Boston Medical Center.

Between 2013 and 2016, safety-net hospitals:

  • reduced heart attack readmissions by 2.86%,
  • decreased heart failure readmissions by 2.78%, and
  • trimmed pneumonia readmissions by 1.77%, according to the study.

 “While the fairness issue remains unresolved, it appears that safety-net hospitals have been able to respond to HRRP incentives,” the researchers pointed out.


That’s not all the researchers discovered, however.

When the study compared safety-net hospitals with other hospitals with high readmission rates at HRRP’s start, they found that, over the 3 years of readmissions data, safety-net hospitals had smaller reductions than the others did.

 “This result,” the researchers explained, “may reflect the difficulties safety-net hospitals have in dealing with factors that influence readmission rates but are beyond the hospitals’ control, such as patient homelessness or lack of family support.”

Rather than lumping safety-net hospitals together with other hospitals, Medicare should consider comparing safety-net hospitals with others of their kind, the study suggested.

“It will be important to continue to monitor the performance of safety-net hospitals under the HRRP,” the researchers concluded.

“If these hospitals fail to respond to HRRP incentives in the future, [federal officials] might consider using different approaches to reducing the hospitals’ readmission rates, such as assessing the rates against the hospitals’ own historical record or exempting the hospitals from the HRRP altogether and focusing on quality-improvement initiatives for them instead.”

How are efforts to reduce readmissions at your facility?  Are many patients coming back into the hospital within 30-days?  Leave us a comment!

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