Readmission penalties increase safety-net hospital burden

By Matt Kuhrt

Medicare's focus on readmissions as a primary metric for determining the quality of care hospitals presents a serious dilemma for safety-net hospitals, according to a blog post from Health Affairs.

As part of the move toward quality-based reimbursement, Medicare imposes penalties on hospitals whose readmission rates exceed limits set by the agency. Early results suggest the program has been successful in reducing readmissions, but FierceHealthFinance reports that success has come at a cost to safety-net hospitals.

The patient mix at safety-net hospitals tends to skew toward individuals more likely to be readmitted than the average, according to Health Affairs. With the higher readmission rates come higher penalties, and since budgets tend to be tight at these hospitals in the first place, the post points out that penalty payments are likely to reduce the resources available to safety-net institutions to make the changes necessary to reduce readmissions.

In order to mitigate this potentially vicious cycle, Health Affairs points to a range of possible fixes:

  • Provide supplemental resources to safety-net hospitals in order to offset the disparity in penalties and assist them in efforts to reduce readmissions among their vulnerable patient populations.
  • Develop a more apples-to-apples comparison system by looking at readmission rates among hospitals in peer groups based on the number of low-income Medicare patients they serve.
  • Revise the quality measures on which the penalties are based to zero in better on readmission metrics that relate to quality of care. As examples, the post suggests shortening the current 30-day window for capturing readmissions and seeking out measures with greater sensitivity for the impact of social determinants of health on patient health.

 To learn more:
- see the post

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