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Hospitals Serving Elderly Poor More Likely to Be Penalized for Readmissions

Centers treating ‘dual eligibles’ pay the price (January 7)

Hospitals that treat more poor seniors who are on both Medicaid and Medicare tend to have higher rates of readmissions, triggering costly penalties from the Centers for Medicare and Medicaid Services (CMS), finds a new study in Health Services Research.

The Hospital Readmission Reduction Program (HRRP) of the CMS is intended to reduce the number of preventable hospital readmissions for patients with pneumonia, heart attack, or heart failure. Hospitals that readmit too many patients within 30 days of their discharge suffer a cut in their Medicare payments of 3% by 2015. The goal of the HRRP is to cut health care expenses by ensuring that patients are stable when they leave the hospital and will not need costly readmissions.

However, a new study of Medicare in-patient claims and other data has found that being dual eligible — both old enough for Medicare and poor enough for Medicaid — increases the risk of a patient’s readmission when the data are adjusted for other risks. Hospitals with more dual-eligible patients were 24% more likely to have readmissions for patients who had heart attacks than hospitals with fewer dual-eligible patients.

Hospitals that treat many dual-eligible patients are more likely to have their payments cut by the CMS under the HRRP, said co-author Lane Koenig, PhD. Many of these hospitals are not financially healthy, he noted. “While these hospitals are more likely to be hurt, they are also more likely to be struggling financially.” Such hospitals may be in areas with fewer or lower quality primary-care resources, which can increase the likelihood that a newly discharged patient ends up back in the hospital within 30 days.

According to a spokesperson for the American Hospital Association, the U.S. Department of Health and Human Services has contracted with the National Quality Forum to convene a panel to evaluate the issue of economic disparities in the calculation of the HRRP and how such information should be handled.

Source: CFAH; January 7, 2013.

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