CMS penalties may stack deck against minority-serving hospitals


Critics of the federal government's readmission penalties have frequently complained the program punishes some hospitals for factors outside their control, and new research confirms that hospitals with large populations of minority patients may be some of the hardest hit.

To gauge how such patient factors affect readmissions, researchers led by Waddah B. Al-Refaie, M.D., chief of surgical oncology at MedStar Georgetown University Hospital, analyzed colorectal surgery outcomes at 374 California providers over a seven-year period, according to a study published in the journal Surgery. About half were classified as "minority-serving" hospitals.

Al-Refaie and his team measured 30-day readmission rates of 11.6 percent for colorectal surgery patients across all the hospitals studied, but that rate was higher--13.6 percent--among minority-serving hospitals. When the readmission period was extended to 90 days, the gap was slightly wider, with 17.4 percent of patients readmitted overall and 20.1 percent of patients readmitted at minority-serving hospitals. 

Inpatient mortality was also more than a percentage point higher for minority-serving hospitals compared to their non-minority-serving counterparts.

A deeper dive into the data determined that patient factors beyond the hospital’s control, such as income, race and whether they were insured, comprised an increased risk of readmission of as much as 65 percent.

"These findings suggest that CMS should account for patient socioeconomic factors when they compare readmission rates," Al-Refaie said in a statement. "These hospitals may become less inclined to take in sicker patients and reduce spending necessary for patient safety, and that puts more patients' health at risk."

In a May webinar, CMS officials acknowledged these weaknesses and said the agency is currently looking into adding such patient factors to its methodology for calculating penalties, FierceHealthcare previously reported.