Cited by 214Healthcare Policy and ManagementHealthcare Quality and ManagementHospital Admissions and Outcomes

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Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program

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Joynt Maddox, Karen E., Reidhead, Mat, Hu, Jianhui, Kind, Amy J. H., Zaslavsky, Alan M., Nagasako, Elna M., Nerenz, David R.·2019·Health Services Research

DOI 10.1111/1475-6773.13133PMC PMC6407348

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Abstract

Objective: Medicare's Hospital Readmissions Reduction Program (HRRP) does not account for social risk factors in risk adjustment, and this may lead the program to unfairly penalize safety‐net hospitals. Our objective was to determine the impact of adjusting for social risk factors on HRRP penalties. Study Design: Retrospective cohort study. Data Sources/Study Setting: Claims data for 2 952 605 fee‐for‐service Medicare beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia from December 2012 to November 2015. Principal Findings: Poverty, disability, housing instability, residence in a disadvantaged neighborhood, and hospital population from a disadvantaged neighborhood were associated with higher readmission rates. Under current program specifications, safety‐net hospitals had higher readmission ratios (AMI, 1.020 vs 0.986 for the most affluent hospitals; pneumonia, 1.031 vs 0.984; and CHF, 1.037 vs 0.977). Adding social factors to risk adjustment cut these differences in half. Over half the safety‐net hospitals saw their penalty decline; 4‐7.5 percent went from having a penalty to having no penalty. These changes translated into a $17 million reduction in penalties to safety‐net hospitals. Conclusions: Accounting for social risk can have a major financial impact on safety‐net hospitals. Adjustment for these factors could reduce negative unintended consequences of the HRRP.

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Authors: Joynt Maddox, K. E., Reidhead, M., Hu, J., Kind, A. J. H., Zaslavsky, A. M., Nagasako, E. M., & Nerenz, D. R.
Affiliations: Cardiovascular Division Department of Medicine Washington University School of Medicine St. Louis Missouri
Missouri Hospital Association Hospital Industry Data Institute Jefferson City Missouri
Henry Ford Health (US)
University of Wisconsin–Madison (US)
Harvard University (US)
Washington University in St. Louis (US)
ORCID: Joynt Maddox, Karen E.
Hu, Jianhui
Kind, Amy J. H.
Zaslavsky, Alan M.
Nagasako, Elna M.
Nerenz, David R.
Venue: Health Services Research
Publisher: Wiley
Published: 2019-03-08
Volume: 54
Issue: 2
Pages: 327-336
ISSN: 0017-9124 (ISSN-L)
1475-6773
DOI: 10.1111/1475-6773.13133
PMC: PMC6407348
OpenAlex: W2920906063
Cited by: 214
References: 35
Citations by year: 2026: 11 · 2025: 21 · 2024: 17 · 2023: 27 · 2022: 33 · 2021: 54 · 2020: 42 · 2019: 9
FWCI: 43.07
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Health Services Research (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Heart, Lung, and Blood Institute (K23HL109177‐03)
National Institutes of Health (R01MD010243, RF1AG057784)
Henry Ford Health System
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
Keywords: Hospital Readmissions Reduction Program, social risk factors, risk adjustment, safety-net hospitals, hospital readmission, Medicare, poverty, housing instability, neighborhood disadvantage, acute myocardial infarction, congestive heart failure, pneumonia, hospital penalties, unintended consequences of health policy
MeSH terms: Age Factors, Aged, Aged, 80 and over, Economics, Hospital, Female, Persons with Disabilities, Disabled Persons, Medicare, Heart Failure, Humans, Insurance Claim Review, Male, Medicaid, Myocardial Infarction, Patient Readmission, Pneumonia, Residence Characteristics, Retrospective Studies, Risk Factors, Socioeconomic Factors, United States, Risk Adjustment, Health Status Disparities, Quality Improvement, Safety-net Providers

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Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program

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