Industry lobbyists are putting the pressure on Congress to use the lame-duck session to pass a law that would take into consideration the challenges faced by hospitals that predominantly treat low-income patients.
America's Essential Hospitals, which represents 275 safety-net hospitals around the country has launched a campaign that includes advertisements in CQ Rollcall and Vox.
This summer, the House unanimously passed a bill that would require the CMS to account for patient socioeconomic status when calculating readmissions penalties.
The Hospital Readmissions Reduction Program (HRRP) aims to reduce preventable readmissions by penalizing hospitals with higher-than-average Medicare readmissions. Safety net hospitals say the program unfairly judges them since their patients are more likely to face social hardships that are outside a hospital's control. For example, this patient population is likely to be poor, be homeless or have issues with literacy and substance abuse.
In August, the CMS revealed that most U.S. hospitals will get less money from Medicare in fiscal 2016 because too many patients return within 30 days of discharge.
Only 799 out of more than 3,400 hospitals subject to the program performed well enough to face no penalty. Thirty-eight hospitals will be subject to the maximum 3% reduction. Those penalties could save Medicare an estimated $538 million, or an increase of about $108 million over the previous year, according to the agency. Hospitals that serve a large volume of low-income patients are 2.67 times more likely than other hospitals to receive penalties under the HRRP, AEH said.
Industry stakeholders are now pushing to pass the Senate version of the bill known as Establishing Beneficiary Equity in the Hospital Readmission Program Act before the end of the year. The Senate Finance committee is looking to attach it to a larger bill, said Shawn Gremminger, director of legislative affairs at AEH. Earlier versions of the House and Senate bill saw no traction when they were introduced in 2014.
Gremminger emphasized that his group supports the purpose of the readmission reduction program, it's just concerned with the one-size-fits-all approach.
“The initiative has had the unfortunate, unintended consequence of taking money from hospitals that are treating the most low-income patients,” he said.
Gremminger said there were concerns that new legislation would let safety net hospitals slide on quality scores.
There also was the belief that legislation would only have a positive impact on states with a large amount of minorities. Industry stakeholders need to convey that any bill would be beneficial for states with a sizeable low-income population as well, Gremminger said.
But those issues have been addressed. That, along with the the bill's bipartisan sponsorship, should ensure passage, Gremminger said.
Others are also optimistic. “We see this as a high priority for the year-end session of Congress," said Erik Rasmussen, vice president of legislative affairs at the American Hospital Association.
Len Marquez, director of government relations for the Association of American Medical Colleges, said he has heard it will all come down to how long Congress is in session.
Another major barrier is that lawmakers had requested HHS study how best to consider socioeconomic status when looking at readmission data.
Lawmakers likely won't move on the legislation until they see the agency's findings, said Blair Childs, senior vice president of public affairs for Premier, which provides healthcare group purchasing and performance-improvement services.
The study is supposed to be released any day, and hopefully it will come out in time before Congress adjourns, Childs said.
A spokeswoman for Sen. Rob Portman (R-Ohio), who co-authored the bill, wouldn't comment on passage, simply saying that he will continue to advocate for the bill.