A program that penalizes hospitals for high early readmission rates of heart attack patients may be unfairly penalizing hospitals that serve a large proportion of African-Americans and those with more-severe illness, a study from the University of Texas Southwestern Medical Center suggests.
The Centers for Medicare and Medicaid Services’ (CMS) Hospital Readmissions Reduction Program, instituted in 2013, reduces payments by up to 3% for hospitals that have high 30-day readmission rates for heart attack, heart failure, or pneumonia.
The study, published in JAMA Cardiology, looked at one-year outcomes for heart attack patients at 377 hospitals. It found no difference in one-year mortality rates and long-term readmission rates between hospitals that were judged to have an excessive readmission ratio (ERR) and those that did not. In addition, hospitals that had been penalized tended to serve higher proportions of ethnic minorities and patients with more-severe disease.
“The current CMS readmission metric does not correlate with long-term clinical outcomes. Furthermore, there is an inequitable distribution of the penalties such that hospitals that treat a greater proportion of socially or medically disadvantaged patients may be unfairly penalized despite comparable quality of care,” said first author Dr. Ambarish Pandey.
The current investigation builds on a 2016 study by Pandey and others that found similar problems with penalties for 30-day readmissions for heart failure. Heart failure patients tend to have many hospital stays.
Together, the findings in the two studies suggest that the readmissions reduction program should be re-evaluated, Pandey said.
According to senior author Dr. James de Lemos, a professor of internal medicine at UT Southwestern, the new study suggests that socioeconomic status should be part of the ERR calculation.
“Our findings raise concern about the fair and equitable allocation of CMS penalties for readmissions,” he said. “Hospitals that take care of larger numbers of patients with socioeconomic disadvantage, including a higher proportion of race and ethnic minorities, are more likely to be penalized, even though quality of care measures and long-term outcomes were not worse for these hospitals. It is fundamentally unfair to penalize hospitals for factors that are beyond their control. We support proposed changes to pay-for-performance that would consider socioeconomic status in the risk-adjustment methods to calculate rewards and penalties.”
Source: UT Southwestern Medical Center; April 26, 2017.