In a recent report, the American Hospital Association expressed concerns with the Hospital Readmission Reduction Program (HRRP), which penalizes hospitals when some patients are readmitted.
Under the HRRP, the Centers for Medicare & Medicaid Services penalizes hospitals if they have a higher than normal readmission rate for heart attacks, pneumonia and heart failure. Hospitals can have their Medicare payments reduced by up to 3 percent per year.
The AHA noted a few potential problems with the HRRP:
- Lack of risk-adjustment for sociodemographic factors, which are usually out of the hospitals’ control
- Including readmissions that are unrelated to the initial admission
- Imbalance between the total penalty amounts relative to the reimbursement for admissions
The AHA recommended that the HRRP focuses only on unplanned readmissions that are related to the initial admission. It also suggested the program include an adjustment for sociodemographic factors, so that hospitals serving low-income and high-risk patients are not penalized disproportionately.
“As CMS increases both the reimbursement at risk and adds conditions to the program, more hospitals will face penalties, further highlighting the urgency of addressing the program’s shortcomings,” the AHA wrote in its report. “The HRRP’s approach to calculating hospital penalties needs refinement to achieve the goal of reducing readmissions without unfairly penalizing hospitals.”