Many of the hospitals that serve our nation’s most vulnerable populations often face a steep penalty, costing them valuable resources and ultimately hurting the very people that the penalty aims to protect: the patient.
In 2012, the Centers for Medicare and Medicaid Services established the Hospital Readmission Reduction Program to reduce acute care hospital readmissions. Hospitals with a high ratio of readmissions, based on the past three years of a hospital’s readmission data compared to the national average, are penalized under the HRRP. In the program’s first year, more than 2,200 hospitals were penalized.
We all support efforts to reduce preventable hospital readmissions. In addition to the HRRP, hospitals, clinicians, consumer and patient groups are working together through the Partnership for Patients to save lives by avoiding hospital-acquired conditions and reducing readmissions. This initiative is working to identify best practices and implement solutions to ensure all patients have the best outcome possible.
The problem with the current HRRP methodology is it assumes that if a hospital has a high proportion of patients readmitted within 30 days, it may be an indication the hospital is providing inadequate care. This is not always the case, however, as there are many factors outside of a hospital’s control that affect readmissions. In fact, there is evidence that hospitals with high mortality rates and low readmission rates fare better under the current HRRP payment methodology than hospitals with low mortality rates, but high readmission rates.
Though the HRRP program serves as an incentive in reducing avoidable rehospitalizations, it does not take into account the added difficulty in preventing readmissions among certain patient populations. Over the past two years, there has been overwhelming evidence that individuals with complex illnesses and those who are economically disadvantaged are at particularly high risk for readmission. Adherence to a treatment regime may prove difficult for disadvantaged patients due to prescription costs, challenging housing situations or difficulty obtaining their medications.
The Commonwealth Fund has found that safety-net hospitals, on average, receive higher penalties under the current methodology used by the HRRP. In fact, 77 percent of the hospitals with the highest share of low-income patients were penalized in the program’s first year. A recent study by the New England Journal of Medicine also highlighted the penalty structure’s shortfalls and urged changes stating that “HRRP will penalize hospitals that care for the sickest and the poorest Americans, largely because readmissions are driven by the severity of underlying illness and social instability at home.” Furthermore, a draft report released in March by the National Quality Forum recommended that measures of health care quality and performance be adjusted for various socioeconomic factors.