Adjusting readmissions data for socioeconomic factors could save thousands

The Centers for Medicare & Medicaid Services intends to incorporate sociodemographic factors into its methodology for determining hospital quality, but in the meantime, some providers are taking the initiative themselves, according to Kaiser Health News.

St. Louis' Christian Hospital faces the loss of nearly $600,000 in Medicare payments due to readmission penalties, However, Steven Lipstein, CEO of the hospital's parent company, BJC HealthCare System, told KHN, that if socioeconomic factors such as chronic illness and income were part of the equation, the penalty would be less than a quarter of that figure.

In the absence of concrete action from CMS, the healthcare industry in the Show Me State has had to take action of its own, according to the article. Earlier in the year, the Missouri Hospital Association (MHA) expanded the data available to consumers on its Focus On Hospitals website. Alongside federal readmissions data, the site now lists statistics adjusted for neighborhood income levels and patients' Medicaid status, much like CMS already lists data adjusted for age and past medical history.

"There is emerging national research that suggest poverty and other community factors increase the likelihood a patient will have an unplanned admission to the hospital within 30 days of discharge," a statement on the site reads. The MHA's analysis, the source of Lipstein's reduced penalty figure, found that adjusting the data for socioeconomic factors could improve readmission rates as much as 88 percent statewide.

Groups such as the American Hospital Association have long decried current CMS methodology as unfair to hospitals in impoverished settings, but Leapfrog Group CEO Leah Binder defended the current methodology, saying the penalties have driven improved care already. "Hospitals are paid a lot of money," she told KHN. "I think they can find a way to handle their readmissions, the way they should have been handling them all along."

To learn more:
- read the KHN article
- here's the statement