Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program
Key result
Adjusting for social risk factors halves readmission disparities, cutting safety-net hospital penalties by ~$17 million.
- n=2,952,605
Why the study?
Medicare's HRRP does not account for social risk factors in risk adjustment, which may lead the program to unfairly penalize safety-net hospitals.
Population
2 952 605 fee-for-service Medicare beneficiaries with AMI, CHF, or pneumonia
Comparison
Adding social risk factors to risk adjustment vs current program specifications
Design
Retrospective cohort study
Authors
Discussion
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Member takes
Implication
Supports incorporating social risk adjustment in HRRP to ease safety-net penalties; leaves open need for prospective validation of equity impact.
Study Design
Type
Cohort (n=2,952,605)
Multicenter
Yes
Structured PICO
P
Population
2,952,605 fee-for-service Medicare beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia
I
Intervention
Adjusting for social risk factors (poverty, disability, housing instability, residence in a disadvantaged neighborhood) in risk adjustment
C
Comparator
Current program specifications (no adjustment for social risk factors)
O
Outcome
HRRP penalties and readmission ratios
Accounting for social risk factors in the Hospital Readmissions Reduction Program significantly reduces financial penalties for safety-net hospitals.
Cite This Study
Maddox et al. (2019) conducted a cohort in Acute myocardial infarction, congestive heart failure, or pneumonia (n=2,952,605). Adjustment for social risk factors vs. Current program specifications (no adjustment) was evaluated on Hospital readmission ratios and HRRP penalties. Adjusting for social risk factors in the Hospital Readmissions Reduction Program halved readmission ratio differences between safety-net and affluent hospitals, reducing penalties by $17 million.