The DOI matches its Crossref record; 34 of the 35 references it cites were found in a registry or an index.
Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program
Open accessAbstract
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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Metadata
- 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
- Venue
- Health Services Research
- Publisher
- Wiley
- Published
- 2019-03-08
- Volume
- 54
- Issue
- 2
- Pages
- 327-336
- ISSN
- 0017-9124 (ISSN-L)
- 1475-6773
- 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
- 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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