Health experts have long warned that federal readmission penalties punish hospitals for outcomes beyond their control, and now new research published in JAMA Internal Medicine suggests the patient population's clinical and social makeup accounts for half the difference between the lowest and highest performers.
Under the standard Medicare formula, which only controls for patient age, sex and certain conditions, the top hospitals have 4.4 percent fewer readmissions than the worst performers. However, when researchers from Harvard Medical School applied a set of 29 more specific variables such as cognition, functional status, income, education and self-reported health, the difference fell to 2.3 percent. This backs up earlier research that found unemployment and the lack of high school education were top socioeconomic factors for readmissions.
These findings indicate that the Medicare formula, intended to provide incentives for improved outcomes, instead penalizes hospitals for having a specific patient population, researchers said in a statement. Worse, "by extension, our findings suggest that the hospitals treating the sickest, most vulnerable patients are being deprived of resources that they could use to take better care of their communities," said lead author Michael Barnett, M.D., of Harvard Medical School and Brigham & Women's Hospital.
To correct for this problem, Barnett and his coauthors suggested several possible improvements to the federal methodology. For example, more detailed risk adjustment could create a better picture of the factors driving readmission, but details about specific patients can be a complicated process. Therefore, the research team believes the solution may require deeper reforms to the Hospital Readmissions Reduction Program, such as realigning the incentives to emphasize improving baseline performance.