Readmission Reduction Program Unfair To Hospitals Treating Low-Income Patients?
By Greg Bengel, contributing writer
Hospitals, lawmakers clash over impact of socioeconomic status of patients as Medicare fines hospitals for excess readmissions
According to recently released federal records, Medicare is imposing $227 million in fines against 2,225 hospitals for excess readmissions in the form of reduced payments for a full year, starting on October 1. The fines are part of the government’s effort to reduce the number of patients readmitted to hospitals within a month of discharge. Eighteen hospitals will lose 2 percent of their Medicare payments, and another 154 will lose 1 percent or more. A complete list of the penalties is posted here.
According to Kaiser Health News, the uneven impact of the penalties is troubling many hospitals. A review of the records reveals that hospitals treating a large number of low income patients are more likely to be penalized than those treating the fewest low-income patients. Specifically, says the article, among safety-net hospitals with the most poor patients, 77 percent were penalized. Compare this result to that of with the fewest poor patients, where only 36 percent were penalized.
The Readmissions Reduction Program differs from other Medicare efforts in that it aims to shift focus from quantity to quality of service. It does not offer hospitals the opportunity to opt out of the program, or offer any rewards for improvements. According to Medicare, the program helps by de-incentivizing a bad incentive. Hospitals earn more money when a patient who left the hospital needs readmitted, as they can bill for two stays instead of one. The Medicare Payment Advisory Commission (MedPAC) says that Medicare could save $1 billion if they stopped only 1 of every 10 readmissions. In addition, MedPAC observes that 12 percent of Medicare patients are being admitted for reasons that may be preventable.
Still, many hospitals accepting low-income patients are upset. According to the Kaiser Health News article, researchers say that low-income patients often have a harder time adhering to post-stay instructions, such as buying certain medications or following a low-salt diet to help reduce health concerns.
Providers and lawmakers do not see eye-to-eye on this point. “The hospital industry has been vocal in its dislike of the penalties, complaining that it should not be punished for patients' health beyond the confines of the hospitals, especially since they get no extra payments for that care,” the article says. On the other hand, “The architects of the health law believed that hospitals have abdicated too much responsibility for their patients and included the penalties to force medical providers to do a better job of working together as patients move to different sites of care.”
Medicare stated in its rule it does not need to take into account socioeconomic status. "We routinely monitor the impact of socioeconomic status on hospitals’ results and have consistently found that hospitals that care for large proportions of patients of low socioeconomic status are capable of performing well on our measures," the agency wrote.
Regardless, readmissions penalties are forcing hospitals treating low-income patients to find ways to help patients post-hospitalization. According to Kaiser Health News, some hospitals are sending nurses to check on patients at their homes or giving free medications.