Hospitals Serving Elderly Poor More Likely Penalized
by Medicare for Readmissions
Medicare reduces payments to penalizes hospitals with
high rates of readmissions for pneumonia, heart attack and heart
failure; those serving poorest seniors have higher readmission rates
By Valerie DeBenedette,
HBNS Contributing Writer
Jan. 7, 2014 - Hospitals that treat more poor
seniors who are on both Medicaid and Medicare tend to have higher rates
of readmissions, triggering costly penalties from the Centers for
Medicare and Medicaid Services (CMS), finds a new study in Health
The Hospital Readmission Reduction Program (HRRP)
of CMS is intended to reduce the number of preventable hospital
readmissions for patients with pneumonia, heart attack or heart failure.
Hospitals that readmit too many patients within 30 days of their
discharge suffer a cut in their Medicare payments of 3 percent by 2015.
The goal of HRRP is to cut healthcare expenses by
ensuring that patients are stable when they leave the hospital and will
not need costly readmissions.
However, a new study of Medicare in-patient claims
and other data has found that being dual eligible - both old enough for
Medicare and poor enough for Medicaid - increases the risk of a
patient's readmission when the data is adjusted for other risks.
Hospitals with more dual-eligible patients were 24 percent more likely
to have readmissions for patients who had heart attacks than hospitals
with fewer dual-eligible patients.
Hospitals that treat many dual-eligible patients
are more likely to have their payments cut by CMS under the HRRP, said
Lane Koenig, Ph.D., president of KNG Health Consulting in Rockville, MD,
and an author of the study. Many of these hospitals are not financially
healthy, he noted. "While these hospitals are more likely to be hurt,
they are also more likely to be struggling financially."
Such hospitals may be in areas with fewer or lower
quality primary-care resources, which can increase the likelihood that a
newly discharged patient ends up back in the hospital within 30 days.
For certain populations, the community may have a
greater effect on whether a given patient is readmitted than the
hospital does, said Bradley Flansbaum, DO, MPH, a hospitalist at Lenox
Hill Hospital in New York City and a member of the Public Policy
Committee of the Society for Hospital Medicine.
"The hospital can do everything right and yet these
patients will still come back," Flansbaum said.
According to a spokesperson for the American
Hospital Association (which took part in and funded the study), the U.S.
Department of Health and Human Services has contracted with the National
Quality Forum to convene a panel evaluating the issue of economic
disparities in the calculation of HRRP and how such information should
Currently, CMS does not take socioeconomic status
into account when calculating readmission rates. It is possible that
adjusting HRRP calculations for socioeconomic data could mask
disparities in quality of care, Koenig said.
"The counter argument is that by not adjusting it,
you may be penalizing hospitals simply because they treat a potentially
sicker or more-difficult-to-manage population."
News Source: Health Behavior News Service,
part of the Center for Advancing Health,
Research Source:Health Services Research,
the official journal of the Academy Health, and published by John Wiley
& Sons, Inc. on behalf of the Health Research and Educational Trust.
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