Bill adds socioeconomic factors to readmissions formula

Senators submitted bipartisan legislature on June 19 to change Medicare’s policy of withholding payments for high rates of readmission to provide better coverage to hospitals working with populations of underserved, disadvantaged and at-risk patients. If put into law, it would change policies outlined in the Hospital Readmissions Reduction Program (HRRP).

As part of the Patient Protection and Affordable Care Act of 2010, HRRP was created to incentivize best care practices and reduce preventable readmissions by withholding payments to those hospitals that have higher-than-average readmission rates for heart failure, acute MI and pneumonia in Medicare patients. The program uses risk adjustment for clinical factors such as illness severity and comorbidities.

The current rate is a 2 percent penalty. An increase is set to occur in 2015 to reflect the maximum of 3 percent.

The authors of the budget-neutral bill noted that high rates of readmission aren’t related to just comorbidities and illness. Certain geographic locations have higher numbers of lower income, less advantaged Medicare patients, for whom outpatient services are hard to come by. Per the bill, “There are numerous socioeconomic conditions that impact health outcomes and the Medicare hospital readmission reduction program is one of many Federal outcome performance programs that fails to accurately adjust for these influences.”

The bill states that in-patient quality of care is not always synonymous to a reduction of readmissions, as patients who lack a support network following discharge will be more likely to require secondary and tertiary hospitalizations.

With this in mind, the Hospital Readmission Accuracy and Accountability Act was developed by U.S. Sens. Joe Manchin (D-W.Va.), Roger Wicker (R-Miss.), Mark Kirk (R-Ill.) and Bill Nelson (D-Fla.) to address these problems seen in their home states.

In a press release, Manchin said, “Failing to recognize this reality has led to unfair penalties at many rural hospitals in West Virginia and around the country, which is why we need to reform this program immediately. Reducing avoidable hospital readmissions is extremely important, and we can only do so by aligning Medicare reimbursements with quality of care.”

“This is one way I think we can improve our healthcare system,” said Nelson in the release. “If you’re going to judge a hospital on readmissions, you should have to take into account, for example, whether it treats more folks who can't afford or don't have access to quality care after being discharged.”

The bill requests that the Hospital Readmission Accuracy and Accountability Act be revised to include socioeconomic or sociodemographic factors into the adjustment calculations.

Wicker stated that, “Our bill would help protect our state’s hospitals by requiring CMS [Centers for Medicare & Medicaid Services] use practical and impartial data to determine these rates going forward.”

No date has been set for a vote on this bill.