Legislators urge CMS to lessen readmission penalties on hospitals that serve poor and elderly

A bipartisan group of U.S. Representatives wants the Centers for Medicare & Medicaid Services to work with Congress to keep Medicare's Hospital Readmission Reduction Program from hurting hospitals that primarily serve elderly, low-income patients and "dual eligibles." 

Thirty-four legislators, led by Rep. James B. Renacci (R-Ohio), wrote to newly-confirmed Health and Human Services Secretary Sylvia Mathews Burwell, that CMS must not penalize hospitals for readmissions unrelated to the original cause of admission.

The lawmakers cited data that indicated readmission rates are often due to community factors rather than hospital quality, leading to penalties for hospitals whose patients are particularly vulnerable.

Renacci is the sponsor of the Establishing Beneficiary Equity in the Hospital Readmission Program Act, which would require the program to factor in socioeconomic status and dual-eligible beneficiaries, according to BNA.com.

"Reducing readmissions cannot be placed squarely on the shoulders of the hospitals. It is a shared responsibility that involves the hospital, the patient, social services professionals and providers across the continuum of care," the letter states. "With the penalty set to increase from a two percent reduction to a three percent reduction on every patient stay payment, we urge CMS to work with Congress to ensure the program is not negatively impacting hospitals that service dually-eligible beneficiaries."

Providers say they consider improving quality of care a high priority, but the penalties are prohibitively high, according to the BNA article. Furthermore, they say, more hospitals receive penalities even as overall readmissions decline nationwide, with readmissions for Medicare patients falling 8 percent between January 2012 and December 2013.

A January study found that hospitals that treat more dual-eligible patients are at increased risk for readmission penalties, FierceHealthcare previously reported. To correct the problem, the study's author suggested CMS alter quality measures to allow hospitals to separately report different dual-eligibility readmission rates.

To learn more:
- here's the letter (.pdf)
- read the article