Karen E. Joynt Maddox|Mat Reidhead|Jianhui Hu|Amy Kind|Alan M. Zaslavsky|Elna M. Nagasako|David R. Nerenz
Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program
Washington University in St. Louis|Henry Ford Health System|Harvard University|Washington University in St. Louis|Henry Ford Health System
objective medicares hospital readmissions reduction program hrrp account social risk factors risk adjustment may lead program unfairly penalize safetynet hospitals objective determine impact adjusting social risk factors hrrp penalties study design retrospective cohort study data sourcesstudy setting claims data 2 952 605 feeforservice medicare beneficiaries acute myocardial infarction ami congestive heart failure chf pneumonia december 2012 november 2015 principal findings poverty disability housing instability residence disadvantaged neighborhood hospital population disadvantaged neighborhood associated higher readmission rates current program specifications safetynet hospitals higher readmission ratios ami 1020 vs 0986 affluent hospitals pneumonia 1031 vs 0984 chf 1037 vs 0977 adding social factors risk adjustment cut differences half half safetynet hospitals saw penalty decline 475 percent went penalty penalty changes translated 17 million reduction penalties safetynet hospitals conclusions accounting social risk major financial impact safetynet hospitals adjustment factors could reduce negative unintended consequences hrrp