Researchers urge tweaks to CMS readmissions program to protect safety net facilities

Two prominent health policy researchers say the CMS' penalty program for readmissions has potential but needs some tweaks in order to protect safety net hospitals.

In a March 6 perspective piece in the New England Journal of Medicine, Dr. Ashish Jha, a professor of health policy and management at the Harvard School of Public Health, Boston, and Dr. Karen Joynt, an instructor in the same department, argued that the federal government's readmissions program has motivated hospitals to ramp up prevention efforts.

Launched Oct., 1, 2012, the program penalizes hospitals up to 1% of their Medicare payments for having higher-than-expected 30-day readmission rates. More than 2,200 hospitals faced penalties in 2013, totaling an expected $280 million, according to CMS projections.

In the article, Jha and Joynt cited recent data from the Medicare Payment Advisory Commission, which showed a modest decrease in national all-cause readmission rates—gains the authors say can hopefully “be sustained over time.”

But the penalty program has also been shown to unfairly impact safety net hospitals and academic medical centers, which serve large numbers of poor, sick patients, they said.

“Left unchecked, the (Hospital Readmissions Reduction Program) has the potential to exacerbate disparities in care and create disincentives to providing care for patients who are particularly ill or who have complex health needs, particularly if the penalties are larger than hospitals' margins for caring for these patients,” they wrote in the article.

Jha and Joynt suggested a number of changes to the program, including adjusting readmission rates for patients' socioeconomic status and weighting penalties according to the timing of readmissions.

“Simple changes to the program could ensure that incentives were provided to hospitals to improve coordination of care without hurting the institutions that care for the most vulnerable patients,” they wrote.