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Changes Suggested for Hospital Readmission Reduction Program

Changes Suggested for Hospital Readmission Reduction Program

Modifications could prevent penalties for hospitals that care for most vulnerable populations

WEDNESDAY, March 6 (HealthDay News) -- To avoid penalizing hospitals that care for the most vulnerable Americans, modifications are suggested for the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP), according to a perspective piece published online March 6 in the New England Journal of Medicine.

Noting that the HRRP primarily consists of financial penalties levied against hospitals with readmission rates deemed to be excessive, Karen E. Joynt, M.D., M.P.H., and Ashish K. Jha, M.D., M.P.H., from the Harvard School of Public Health in Boston, discuss the concept of penalizing hospitals.

The authors note that there was a small, but significant, decrease in national rates of all-cause readmission, from 15.6 percent in 2009 to 15.3 percent in 2011. It is hoped that this decrease represents a beneficial effect from the readmission-prevention activity in U.S. hospitals generated by the HRRP. Two-thirds of eligible U.S. hospitals were found to have higher readmission rates that the CMS models predicted, resulting in a much higher number of hospitals that may be penalized, including safety-net hospitals. To avoid harming hospitals, specifically ones caring for socially and clinically vulnerable populations, suggested measures include adjustment for socioeconomic status, weighting the HRRP's penalties according to readmission timing, and giving hospitals credit for low mortality rates.

"No policy is ever perfectly designed at inception, and policies should be changed as new evidence emerges," the authors write. "The latest data also make it clear that the HRRP will penalize hospitals that care for the sickest and the poorest Americans, largely because readmissions are driven by the severity of underlying illness and social instability at home."

Full Text (http://www.nejm.org/doi/full/10.1056/NEJMp1300122?query=featured_home )