About two-thirds of hospitals starting this month will face penalties for excess readmission rates. But according to critics of what is likely the biggest change to Medicare policy in decades, many readmissions are caused by social factors outside of hospitals' control.
Under the Readmissions Reduction Program, the Centers for Medicare & Medicaid Services does not consider social factors, such as patients' income level, employment status, race, education and age, Reuters Health reported.
For instance, nonwhite, elderly patients are at particular risk for pneumonia and heart failure readmissions, according to a Journal of General Internal Medicine study this month.
Lead author Linda Calvillo-King, an assistant professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas, noted patients were readmitted because they could not get to their doctors' offices or take their medication.
Correlations between social-economic factors have been linked to readmissions. A separate study in the September American Journal of Transplantation found that older, African-Americans who received kidney transplants were at higher risk of early readmission, with a nearly 11 percent increased risk compared with non-African-American patients, Renal & Urology News reported.
However, Calvillo-King and other researchers said they can't say for sure whether these social factors directly cause readmissions.
"We don't yet know how to accurately measure (the factors), but I think we found enough information to say that they are important and that they should continue to be studied and accounted for," Calvillo-King said in the Reuters article. "As a physician, these are things that should be taken into account or publicly reported," she added.
Further study of those socio-economic factors may help hospitals determine at-risk populations. For example, a separate study in the American Journal of Public Health found that a home address can serve as a vital sign, helping hospitals predict which children will be readmitted for asthma or are at risk for an emergency department visit. Although most children receive the same inpatient care despite differences in socioeconomic status, poor, urban and minority children are at the highest risk for ED treatment and hospital admission, according to lead study author Andrew Beck, a pediatrician at Cincinnati Children's Hospital Medical Center.
Although asthma is not a condition that CMS reduces reimbursements for excess readmissions, having that data could help hospitals weigh environmental conditions to help their patients from bouncing back to the hospital, which could similarly be applied to the CMS-measured conditions of pneumonia, heart failure and acute myocardial infarction.
"The use of this data to help identify children admitted to the hospital with asthma who may need more aggressive, targeted assessments and/or interventions may prevent asthma attacks and reduce disparities," Beck said in a statement Thursday.
For more information:
- read the Reuters Health article
- check out the JGIM study
- here's the Renal & Urology News article
- check out the American Journal of Transplantation study abstract
- see the Cincinnati Children's statement and study abstract
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