Accounting for social risk factors can help safety-net hospitals avoid readmission penalties

Social risk factors, such as poverty, can affect readmissions to safety-net hospitals, thereby affecting federal penalties for readmission rates, according to a study published in Health Services Research.

CMS' Hospital Readmissions Reduction Program places financial penalties on hospitals with high readmission rates. Safety-net hospitals, which provide care regardless of a patient's ability to pay, tend to be at the receiving end of those penalties, as the program's current performance model does not account for social risk factors.

Researchers from Detroit-based Henry Ford Health System created a risk adjustment model that incorporates social risk factors. They studied claims data for nearly 3 million fee-for-service Medicare patients who were hospitalized for heart attack, congestive heart failure or pneumonia from December 2012 to November 2015.

They found social risk factors, including poverty, disability and living in a disadvantaged neighborhood, were associated with higher readmissions in all three medical conditions.

However, when the risk adjustment model incorporated social risk factors, safety-net hospitals saw a significant decrease in readmissions rates for all three medical conditions as compared to their counterparts that are more affluent.

Researchers estimated that safety-net hospitals would see a 21.8 percent reduction in penalties, or around $17 million, if their risk adjustment model was used. Meanwhile, affluent hospitals would see a 22 percent increase in penalties.

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