AHA wants ethnic factors considered in readmissions program

HHS should include patient characteristics such as race and limited English proficiency in its risk-adjustment methodology as it implements the hospital readmissions-reduction program outlined in the healthcare reform law, according to a letter (PDF) Tuesday from American Hospital Association President and CEO Richard Umbdenstock to CMS Administrator Dr. Donald Berwick.

The hospital readmissions reduction program, or HRRP, was included in the Patient Protection and Affordable Care Act and offers financial incentives to hospitals that treat Medicare beneficiaries to reduce preventable readmissions. According to AHA’s letter, racial disparities extend to hospital readmissions, and a Journal of the American Medical Association article this year reported that hospitals serving a disproportionately large number of minorities have higher readmission rates. Therefore, AHA asserted, a hospital could be penalized under the HRRP for serving large numbers of minority patients than for actually providing poor care.

“Stated differently, the HHRP may disproportionately affect hospitals serving a large number of minorities,” the letter said. “And, by penalizing these hospitals, the HRRP will in turn disproportionately harm minority patients.”

Although Congress incorporated a risk-adjustment methodology to account for differences among hospital patient populations to avoid unintended consequences, traditional risk-adjustment methodologies will not be enough to achieve that goal, AHA concluded.

“We urge HHS to recognize that patient characteristics beyond those such as medical diagnosis, age and gender greatly affect health status,” Umbdenstock wrote. “As it implements the HRRP, HHS should incorporate these additional characteristics into its risk-adjustment methodology,” to comply with the law and avoid penalizing the very providers who are trying to eliminate racial disparities in healthcare.