Case Management

JAMA opinion piece urges modifications to Readmission Reduction Program

Case Management Insider, August 18, 2015

Safety-net hospitals are unfairly penalized by CMS’ Hospital Readmission Reduction Program (HRRP), according to an opinion piece in the July 28 issue of the Journal of the American Medical Association (JAMA).

While hospitals should be held accountable for readmissions in order to reduce these unnecessary and costly return visits to the hospital, some hospitals penalized disproportionately by the HRRP, wrote authors Andrew S. Boozary, MD, MPP, of the Department of Health Policy and Management at the Harvard School of Public Health in Boston, U.S. Senator Joseph Manchin III, (D-West Virginia) and U.S. Senator Roger F. Wicker, JD (R-Mississippi). The authors said that while CMS readmission penalties are an effective means of holding hospitals accountable for avoidable readmissions (which cost Medicare some $26 million each year), evidence now shows that hospital that serve large, low-income, and chronically ill populations are being unjustly penalized for readmissions.

“Asking hospitals to be accountable for readmissions is an important step forward, but a closer look at the effect of the HRRP reveals important concerns about the complexity of readmissions and what drives them,” wrote the authors.

Three years of data clearly shows that hospitals that serve large, low-income, and chronically ill patients are far more likely to be penalized for readmissions than other hospitals, with safety-net hospitals nearly 60% more likely to have gotten penalties in all three years studied.

“Hospitals should not be penalized simply because of the demographic characteristic of their patients. However the evidence indicates that HRRP is doing exactly that,” wrote the authors.

Change is in order, which is why Senators Manchin and Wicker proposed The Hospital Readmissions Program Accuracy and Accountability Act of 2014 last fall. The bill would require CMS to take socioeconomic status into account when calculating penalties.

The bill, which accompanies a similar initiative in the U.S. House of Representatives, would both preserve the accountability of the HRRP while not unduly burdening safety-net hospitals, according to authors.

Most Popular