Readmission penalties unfairly hurt urban hospitals, critics say

Hospitals nationwide are trying to keep patients from returning to their facilities, especially with Medicare penalizing institutions with high readmissions rates starting in 2013. But urban hospitals could lose millions of dollars under Congress' Hospital Readmissions Reduction Program, and not necessarily because of inferior care.

The most repeat readmissions are linked with high-poverty locations, according to a study by Memphis-Tenn.based Qsource, reported The Tennessean yesterday. That's why Dr. Sunil Kripalani, chief of hospital medicine at Vanderbilt University, wondered whether it's fair to measures inner-city hospital readmissions like those in affluent suburbs. He noted that the readmission rate formula doesn't take into account race, education, or access to care.

Under the formula, hospitals in Nashville would see significantly reduced reimbursement, as the North Nashville ZIP codes of 37218 and 37207 both have "high repeat utilizers" who rack up at least four readmissions a year, according to the article.

To combat these inequalities, urban hospitals should focus on improving follow-up care and establish programs that ensure discharged patients get the necessary meals, medicine, and transportation, noted The Tennessean. Hospitals and community groups also can apply for part of $500 million in federal grant funds.

Similarly, a September report from the American Hospital Association (AHA) suggested that correlating factors such as socioeconomic class, support, and comorbidity may influence readmission rates.

"Payment penalties intended to shrink readmission rates could exacerbate inequities and leave hospitals with fewer resources to make needed investments in improving patient care," states the report.

For more information:
- read The Tennessean article