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


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...


health policy Medicare risk-adjustment vulnerable populations 



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.


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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

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