Advertisement

Journal of General Internal Medicine

, Volume 34, Issue 1, pp 26–28 | Cite as

Health Equity and Hospital Readmissions: Does Inclusion of Patient Functional and Social Complexity Improve Predictiveness?

  • Geoffrey J. HoffmanEmail author
  • Charleen Hsuan
  • Thomas Braun
  • Ninez Ponce
Concise Research Reports
  • 188 Downloads

BACKGROUND

Medicare’s Hospital Readmissions Reduction Program (HRRP) was intended to encourage hospitals to improve care for older adults. However, the program has raised health equity concerns because its risk-adjustment model does not account for patient social complexity; the concern is that HRRP may aggravate healthcare disparities by penalizing financially challenged hospitals and reducing their resources to improve care.1 While the HRRP assesses hospitals for penalties based upon readmission performance that is adjusted for patient age, sex, and clinical severity of illness, it does not account for functional and social patient factors. Because of this, it may assume similar readmission risk for hospitals that treat more or fewer functionally and socially complex patients, even if risks appreciably differ for these patients. As a result, the program may generate unwarranted penalties and financial pressure for resource-scarce hospitals that serve socially complex patients.1, 2, 3...

KEY WORDS

health policy Medicare risk-adjustment vulnerable populations 

Notes

Acknowledgments

This work was presented at the 2018 AcademyHealth Annual Research Meeting in Seattle, WA, on Sunday, July 24, 2018.

Compliance with Ethical Standards

Conflict of Interest

Thomas Braun receives some salary support from OncoImmune for his work as a biostatistician on a Phase II drug trial. Ninez Ponce has a position on the multicultural advisory board for Nielsen, Inc. All remaining authors declare that they do not have a conflict of interest.

References

  1. 1.
    National Quality Forum. Risk adjustment for socioeconomic status or other sociodemographic factors. Washington, DC: National Quality Forum; August 2014.Google Scholar
  2. 2.
    MedPAC. The hospital readmission penalty: How well is it working? 2015; http://www.medpac.gov/-blog-/medpacblog/2015/03/24/the-hospital-readmission-penalty-how-well-is-it-working. Accessed July 25, 2018.
  3. 3.
    Mellor J, Daly M, Smith M. Does It pay to penalize hospitals for excess readmissions? Intended and unintended consequences of Medicare's Hospital Readmissions Reductions Program. Health Econ 2016:n/a-n/a.Google Scholar
  4. 4.
    Yale/CORE. 2015 measure and specifications report: Hospital-wide all-cause unplanned readmission measure. New Haven, CT: Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation (YNHHSC/CORE); March 2015 2015.Google Scholar
  5. 5.
    Joynt KE, Jha AK. A path forward on Medicare readmissions. N Engl J Med 2013;368(13):1175–1177.CrossRefGoogle Scholar
  6. 6.
    Office of the Assistant Secretary for Planning and Evaluation. Social risk factors and performance under Medicare’s Value-Based Purchasing programs. Washington, D.C.: Department of Health and Human Services; December 2016 2016.Google Scholar

Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Geoffrey J. Hoffman
    • 1
    • 2
    Email author
  • Charleen Hsuan
    • 3
  • Thomas Braun
    • 4
  • Ninez Ponce
    • 5
  1. 1.Department of Systems, Populations and LeadershipUniversity of Michigan School of NursingAnn ArborUSA
  2. 2.University of Michigan’s Institute for Healthcare Policy and InnovationAnn ArborUSA
  3. 3.Department of Health Policy and AdministrationPenn State University College of Health and Human DevelopmentUniversity ParkUSA
  4. 4.Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborUSA
  5. 5.UCLA Fielding School of Public HealthLos AngelesUSA

Personalised recommendations