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Bill Proposes Risk-Adjusting Medicare Readmissions Program

ways and meansA new bill introduced in the House Ways and Means Committee would apply risk adjustment for socio-economic factors to Medicare’s hospital readmissions reduction program.

According to a committee summary of the bill, The Helping Hospitals Improve Patient Care Act of 2016 includes a provision that would direct the Secretary of Health and Human Services to

… implement a transitional risk adjustment methodology to serve as a proxy of socio-economic status for the Hospital Readmissions Reduction Program. In addition to the transitional adjustment, the section clarifies that the Secretary is able to permanently use a more refined methodology following the analysis required by the Improving Medicare Post-Acute Care Transformation Act of 2014. The section also requires a study by the Medicare Payment Advisory Commission (MedPAC), and allows for an analysis of “V-codes” and an exploration of potential exclusions.

The National Association of Urban Hospitals has long called for socio-economic risk adjustment of the readmissions reduction program (most recently here), maintaining that the large numbers of low-income patients private, non-profit urban safety-net hospitals serve are more challenging to treat than typical hospital patients and more likely to require post-discharge readmission to address continuing medical and social issues.

For a closer look at the bill’s socio-economic risk adjustment provision and other proposals, go here to see the committee’s summary of H.R. 5273, The Helping Hospitals Improve Patient Care Act of 2016, and go here to see the bill itself.

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