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A Closer Look at Medicare’s Hospital Readmissions Reduction Program

The Medicare hospital readmissions reduction program is one of the more prominent components of the Affordable Care Act.

Too many Medicare patients require readmission to the hospital too quickly after their discharge, critics maintain, and reducing those admissions would both improve the health of those patients and reduce Medicare’s costs.  Hospitals are employing a number of approaches to reducing Medicare readmissions and early evidence has produced cause for optimism.

Medical EquipmentIn a new health policy brief, the Robert Wood Johnson Foundation and the journal Health Affairs describe the readmissions reduction program, present a number of the strategies hospitals are employing to reduce their Medicare readmissions, and outline some of the challenges the program has encountered during its first two years.  One of those challenges is the manner in which the program treats safety-net hospitals.   The report notes that one of those challenges

…centers on whether hospitals are being treated fairly, especially those hospitals that care for the sickest and most vulnerable patients.  They question whether hospitals should be held accountable for things beyond their control, such as patient behavior and postacute care provider performance.

The report goes on to note that

A major objection is that there is no adjustment for the socioeconomic status of patient populations.  Critics point to a number of factors that contribute to higher readmission rates for the poor, such as language and cultural barriers to complying with discharge instructions, lack of resources to purchase medications, and fewer options for postdischarge care.

NAUH has made this very argument to the Centers for Medicare & Medicaid Services (CMS) on several occasions, most recently in a June 234, 2013 letter conveying NAUH’s concerns about selected aspects of the proposed FY 2014 Medicare inpatient prospective payment system regulation.  That letter can be found here.

The Robert Wood Johnson Foundation/Health Affairs policy brief on the Medicare hospital readmissions reduction program can be found here.

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