Hospitals Cut Readmissions, but at What Cost?
Critics say Medicare program penalizes safety-net hospitals
Report says that safety-net hospitals should be compared to other safety-net hospitals, rather than put into one broad category. Photo by EunikaSopotnicka/iStock
Safety-net hospitals, which serve large populations of low-income patients, have made significant progress in reducing patient readmissions under a federal penalty program, but adjustments to the program should be considered, says a new study led by a Boston University School of Public Health (SPH) researcher.
The study, published online by Health Affairs, looked at the effects of Medicare’s Hospital Readmission Reduction Program (HRRP), which penalizes hospitals for high 30-day readmission rates for patients discharged for pneumonia, heart attack, and heart failure. Critics of the program have argued that the program disproportionately penalizes safety-net hospitals because they serve many low-income patients who lack post-hospitalization resources, such as primary care and social support, and have a higher probability of being readmitted.
Led by Kathleen Carey, an SPH professor of health law, policy, and management, the study found that, in the first three years of the program, safety-net hospitals reduced readmissions for heart attacks by 2.86 percentage points, for heart failure by 2.78 percent, and for pneumonia by 1.77 percent. Those improvements, between 2013 and 2016, were greater than those achieved in other hospitals.
The disparity in readmission rates between hospitals serving large shares of low-income patients and those serving lower populations of poor patients also declined.
But the study also found that, when compared with other hospitals that had high readmission rates to begin with, safety-net hospitals had smaller reductions.
“This result 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,” write Carey and her co-author, Meng-Yun Lin, a research data analyst at Boston Medical Center.
The authors urge modifications to the HRRP, saying, “Policy makers should bear in mind that a penalty program may not provide the best lever for incentivizing performance improvement in safety-net hospitals.”
They say their findings support a recommendation that the Medicare program be adjusted so that safety-net hospitals are evaluated against other safety-net hospitals, rather than put into one broad category.
“It will be important to continue to monitor the performance of safety-net hospitals under the HRRP,” the study concludes. “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.”
The study was funded, in part, by a grant from the Agency for Healthcare Research and Quality.
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