The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations
Article first published online: 13 JAN 2014
© Health Research and Educational Trust
Health Services Research
Volume 49, Issue 3, pages 818–837, June 2014
How to Cite
Gu, Q., Koenig, L., Faerberg, J., Steinberg, C. R., Vaz, C. and Wheatley, M. P. (2014), The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations. Health Services Research, 49: 818–837. doi: 10.1111/1475-6773.12150
- Issue published online: 16 MAY 2014
- Article first published online: 13 JAN 2014
- Association of American Medical Colleges
- American Hospital Association
- dual eligibles;
- Affordable Care Act
To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations.
Data Sources/Study Setting
Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics.
Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP.
Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations.
Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations.