CMS readmission reduction program is unfair, needs redesign, Harvard study suggests

Penalties for high readmission rates, imposed by CMS, unfairly punish hospitals that provide care for more vulnerable patients, according to research out of Harvard Medical School.

This is because Medicare does not include the social and clinical characteristics of a hospital's patient population, the study authors argue. The study was published in JAMA Internal Medicine.

"The readmissions reduction program is designed to penalize hospitals for poor quality of care, but our findings suggest that hospitals are penalized to a large extent based on the patients that they serve," said J. Michael McWilliams, MD, PhD, an associate professor of healthcare policy and medicine at HMS and practicing internist at Brigham and Women's Hospital in Boston.

Dr. McWilliams and other researchers used nationally representative survey data and linked Medicare claims to asses 29 characteristics not included in Medicare's standard adjustments as potential predictors for 30-day readmissions. (Currently, Medicare adjusts for patients' age, sex, discharge diagnosis and recent diagnoses.)

Researchers then compared the distribution of the 29 characteristics between beneficiaries admitted to hospitals with higher or lower readmission rates, and also compared differences in the probability of readmission between the groups of participants before and after making the adjustments.

Hospitals that had the highest readmission rates also had patients who were "less mobile, had more difficultly with activities of daily living, more chronic conditions, less education, lower income, lower assets, and the list goes on and on," Dr. McWilliams told The Washington Post.

Michael Barnett, MD, research fellow in medicine at Harvard Medical School and the study's lead author, added, "Our findings suggest that the hospitals treating the sickest, most vulnerable patients are being deprived of resources that they could use to take better care of their communities," because they are being penalized financially through the readmissions reduction program.

The study authors suggest that the Hospital Readmissions Reduction Program could be in need of a redesign to minimize unintended consequences. They suggest the possibility of replacing inadequate adjusted comparisons against national averages with incentives for hospitals to improve on their own baseline performance.

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