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Study: Readmission Penalties Are Punishing Safety-Net Hospitals

CMS needs to consider socio-economic factors, authors find

Rather than medical treatments, health disparities are the key drivers of readmissions at hospitals treating underserved populations, according to a report from HealthLeaders Media News. Socioeconomic factors such as race, income, and insurance status have a major influence on readmissions, researchers say.



Investigators at MedStar Georgetown University Hospital in Washington, D.C., studied readmissions after colorectal surgery, which has a high risk for postoperative complications and hospital readmissions within 30 days of discharge. The team examined outcomes and socioeconomic factors in more than 168,000 colorectal surgery patients treated at 374 California hospitals from 2004 to 2011.

Forty-seven of these hospitals were considered minority-serving facilities, treating a high percentage of minority patients. Hispanics and blacks comprised 63% of the patient population in minority-serving hospitals, compared with 17% in other hospitals.

After accounting for a patient’s age, gender, comorbidities, and year and type of procedure, the researchers found that, overall, 30-day, 90-day, and repeated readmission rates were 12%, 17%, and 3%, respectively. In comparison, the rates in minority-serving hospitals were 14%, 20%, and 4%, respectively. Inpatient mortality was also significantly higher at minority-serving hospitals (4.9%) compared with non–minority-serving hospitals (3.8%).

The Centers for Medicare and Medicaid Services (CMS) takes the view that all hospitals should be held to the same readmission standard, noted senior investigator Waddah B. Al-Refaie, MD, FACS, surgeon-in-chief at Georgetown Lombardi Comprehensive Cancer Center. But that standard comes with a high price: So far, the Hospital Readmission Reduction Program has penalized more than half of the nation’s hospitals for failing to meet expectations, imposing more than $500 million in fines to date.

“If these factors are not balanced out, we fear minority-serving hospitals will face substantial, crippling financial penalties, and may end up being selective about the patients they admit,” Al-Refaie said.

The study’s findings suggest that the CMS should account for patients’ socio-economic factors when they compare readmission rates, he added.

Sources: HealthLeaders Media News; November 10, 2016; and Surgery; October 27, 2016.

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