Associations between readmission disparities and hospital equity efforts: an analysis of U.S. hospitals

BACKGROUND: Inequities in healthcare delivery and outcomes remain pervasive. The United States’ Centers for Medicare and Medicare Services (CMS) started confidentially reporting to hospitals data on disparities in readmission rates for Medicare beneficiaries in 2019. Whether hospitals with readmission disparities are more likely to establish equity efforts is an important policy question. We examined relationships between hospitals with readmission disparities for Medicare beneficiaries in 2019, and hospital equity efforts in 2022, measured by (a) the presence of an equity officer and (b) the strength of a hospital’s equity environment. METHODS: We conducted a retrospective study of US hospitals in the American Hospital Association Annual Survey that were eligible for CMS’ Hospital-Wide Readmission and Disparity measures using 2019 Medicare data. Outcomes: hospital equity efforts in 2022 measured by the presence of a hospital equity officer and a hospital’s equity environment composite score. Exposure: Disparities in 2019 Medicare readmissions by insurance (dual-eligible vs. non-dual-eligible patients) and by race (Black vs. White patients). Covariates: hospital characteristics. We used regression analyses to examine relationships between hospitals with and without disparities in readmissions in 2019 (by insurance and race separately) and our two outcomes. RESULTS: 2019 hospital-level disparities by insurance conferred a 1.35 times increased odds (95% CI: 1.17–1.56) of having an equity officer and 0.76 (0.22) point increase in equity environment composite scores in 2022 in unadjusted analyses. These relationships were not significant after adjusting for hospital covariates. There was no relationship between disparities by race and 2022 equity efforts. CONCLUSIONS: Our findings suggest that hospital-level readmission disparities do not necessarily incentivize hospital-level equity efforts. Hospital organizational type, which likely influences not only its patient population but also hospital culture, may be a stronger predictor of hospital equity efforts. This study contributes to the discussion of how we measure, report on and create accountability to equity at the hospital-level.