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Readmissions may say more about patients than care

Hospital readmissions that Medicare penalizes under the Affordable Care Act are largely driven by patient characteristics such as income and education rather than the quality of care they receive, according to a new study.

The report, published online by JAMA Internal Medicine, identified 22 characteristics that are associated with higher probabilities of readmission but aren't taken into account by the CMS.

"This finding suggests that Medicare is penalizing hospitals to a large extent based on the patients they serve," the authors conclude.

Previous studies have concluded that hospitals in poor areas and urban hospitals have been disproportionately penalized under the program. In fiscal 2016, about 1,600 hospitals will see their based operating DRG payments knocked down as much as 3%.

Medicare's Hospital Readmissions Reduction Program adjusts its 30-day readmission measures for age, sex, discharge diagnosis and recent diagnoses.

For the study published Monday, researchers at Harvard Medical School looked at data from the Health and Retirement Study (a longitudinal study of 20,000 Americans) and Medicare claims to evaluate the influence of a broader array of factors than considered in previous research.

Their findings come as the CMS and healthcare quality experts wrestle with how to refine Medicare's readmissions measures without letting hospitals off the hook if they serve more challenging patient populations.

The National Quality Forum is working with Medicare officials to develop a two-year trial with measures that are risk-adjusted for factors such as socio-economic and demographic characteristics.

Using additional factors to determine the penalties has also been recommended by the Medicare Payment Advisory Commission, the American Hospital Association and other groups.

In March, Sen. Joe Manchin (D-W.Va.) re-introduced legislation that would reform the calculation of the readmissions penalty to factor in socio-economic characteristics of patients. A similar bill died in 2014. Neither bill proposed specific changes.


Shannon Muchmore

Shannon Muchmore reports from Washington on health politics and policy. Before joining Modern Healthcare in 2015, she was the health reporter at the Tulsa (Okla.) World. She has a bachelor’s degree in news editorial journalism from Oklahoma State University.

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