Shift to hospitalwide readmission measures would hurt safety-net, other hospitals

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The change would also lead to more hospitals overall that are hit with penalties, according to the study.

Adjusting Medicare's Hospital Readmissions Reduction Program (HRRP) to measure readmissions hospitalwide instead of looking at specific conditions would significantly increase penalties for safety-net hospitals, according to a new study. 

Such a change, advocated by groups such as the Medicare Payment Advisory Commission, would also mean more hospitals overall would be hit with penalties, albeit by a smaller margin, according to the study, which was published in the New England Journal of Medicine.

RELATED: Medicare hits half of U.S. hospitals with readmission penalties 

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Researchers led by the Harvard T. H. Chan School of Public Health, the University of Michigan Institute for Healthcare Policy and Innovation and the Department of Health and Human Services evaluated more than 6.7 million readmissions under a hospitalwide measure and 4.3 million readmissions under a condition-specific measure, pulled from Medicare data recorded between 2011 and 2013. 

Of the 3,443 hospitals included in the study, 688 were considered safety-net facilities. The study found that 76 more hospitals would be penalized under a hospitalwide readmissions measure and that Medicare payment reductions would likely increase modestly across the board. 

"There is support for changing to a hospitalwide readmission measure to broaden hospital eligibility and provide incentives for improvement across more conditions," according to the study. 

The jury is still out on whether or not financial penalties do indeed reduce readmissions and improve care quality. A study published in January found that hospitals hit with the most severe penalties improved rates in target conditions such as heart attack, heart failure and pneumonia.

Hospitals that performed the worst prior to HRRP's introduction in 2010 improved the most since it was launched, that study found. 

However, other recent research has suggested that lower readmission rates don't necessarily correlate to better quality care. In particular, HRRP penalties disadvantage hospitals that treat large numbers of low-income patients, that study found. 

RELATED: Persistent readmission rate penalties are counterproductive 

“It is fundamentally unfair to penalize hospitals for factors that are beyond their control,” said the study's senior author, James de Lemos, M.D., professor of internal medicine the University of Texas Southwestern Medical Center. 

HRRP penalties have also been criticized by major professional groups, including the American Hospital Association.

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