3 Changes to Make Hospital Readmission Penalties Fairer

While CMS' Hospital Readmissions Reduction Program has the potential to improve patient care and hospital quality, its calculation method for determining penalties may unfairly penalize high-performing hospitals and safety-net hospitals, according to a perspective piece in the New England Journal of Medicine.

Under HRRP, CMS will cut a percentage of hospitals' Medicare payments if they have higher-than-expected readmission rates for certain conditions. The program aims to improve patients' health and make hospitals accountable for providing high-quality, coordinated care.


However, the method for determining hospitals' penalties does not take into account patients' socioeconomic status, severity of illness and mortality rates. Evidence suggests that safety-net hospitals, which care for a disproportionate amount of socioeconomically disadvantaged patients, are more likely to be highly penalized under the readmission program. In addition, sicker patients may be readmitted due to their underlying disease and not due to a lack of coordination by the hospital. Finally, some hospitals with high readmission rates have lower mortality rates, while some hospitals with low readmission rates have higher mortality rates, according to the report.

The authors suggested three changes to the readmission program to more fairly penalize hospitals:

1. Adjust readmission rates for socioeconomic status.

2. Weight penalties according to the timing of readmissions.

3. Factor in hospitals' mortality rates.

More Articles on Hospital Readmissions:

Study: All-Cause Readmissions Yield Artificially High Rates
CMS: Hospital Readmissions Down to 17.8%

Study: Higher Readmission Rates Don't Mean Lower Mortality Rates for Heart Attack, Pneumonia

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