Hospital readmissions reduction program penalizes safety net hospital clinicians

OBJECTIVE: The Hospital Readmissions Reduction Program (HRRP), started under the Patient Protection and Affordable Care Act and administered by the Centers for Medicare and Medicaid Services, was created with the intention to improve healthcare quality and costs. However, research on disparities in healthcare demonstrates the HRRP's protocolized risk-adjustment calculations neglect social factors, which consequently harms disadvantaged patient populations and unfairly contributes to clinician and hospital penalties. METHODS: A PRISMA literature review was conducted using PubMed and Cochrane Library to explore the inclusion of social factors such as socioeconomic status on risk-adjustment calculations, and their relation to healthcare disparities, penalties, and outcomes. Fifteen articles published in the past 10 years were reviewed. RESULTS: Eleven (73%) of the 15 articles in this systematic review indicated that the HRRP potentiated healthcare disparities based on risk-adjustment calculation. CONCLUSIONS: This review strongly suggests modifying the HRRP risk-adjustment calculations to include social risk factors has the potential to equalize reimbursement for hospitals that serve the most vulnerable patients and reduce negative unintended consequences of the HRRP. Future studies are needed to produce more conclusive, consistent evidence on the effect of social risk factors in risk-adjustment calculations and associated outcomes and to determine how HRRP's risk-adjustment calculations can be modified to reduce disparities in healthcare.