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Big-city hospitals more likely to face readmission penalties

Hospitals in Chicago, Detroit, New York City, Newark, N.J., and Philadelphia saw the highest average Medicare readmission penalties over the past two reporting periods, according to researchers studying the impact of the program on urban institutions.

There is a significant correlation between a hospital's penalties and the size of the city's population, according to their preliminary findings presented in a poster session Monday at the American Heart Association's Scientific Session in Chicago.

Using U.S. Census data, researchers from Wayne State University in Detroit, Rush University in Chicago and the University of Michigan in Ann Arbor identified the cities with the largest populations in each of the 49 states in the readmissions program (Maryland is excluded because of its Medicare waiver). They pulled socio-economic data for each city, including the percentage of the population without a high school diploma, the number of unemployed or underemployed, as well as information on total household income. They then used CMS data to look at the average readmission penalties in each city in 2013 and 2014 and compare each city's average with the average in the rest of the state.

The average CMS penalties were consistently higher for hospitals in large urban areas, where education, employment and household income rates were lower.

“They are being penalized heavily,” said Dr. Muhammad Hamid of Wayne State. Hamid and his colleague, Dr. Arshad Javed, also from Wayne State, presented the preliminary findings.

In 2012, the CMS began docking hospitals' reimbursements when excessive numbers of patients returned to the hospital within 30 days of discharge. Hospitals with high numbers of patients readmitted after treatment for heart attack, heart failure and pneumonia began having Medicare payments docked up to 1% in fiscal 2013. That number increased to 2% in fiscal 2014. This year, the CMS measured readmissions for two more conditions: joint replacements and respiratory diseases. A total of 2,610 U.S. hospitals will see their Medicare payments docked in fiscal 2015, according to data published in October.

Several other recent studies have suggested that socio-economics are skewing the fairness of the program, and leading patient-safety experts have spoken out in support of adjusting for these factors.

Javed, chief author of this latest study, said the program is putting hospitals that serve poorer, under-employed and under-educated patients in a Catch-22. “If they don't get reimbursement, they will get more penalties.”

Follow Sabriya Rice on Twitter: @Sabriyarice


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