AAMC President and CEO Darrell G. Kirch, M.D., March 10 commended Rep. Jim Renacci (R-Ohio), Rep. Eliot Engel (D-N.Y.), Sen. Rob Portman (R-Ohio), and Sen. Joe Manchin (D-W.V.) for introducing the Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015 (H.R. 1343, S.688), bipartisan legislation that would amend the Hospital Readmissions Reduction Program (HRRP) to account for socioeconomic status factors of patients.
In a statement, Dr. Kirch applauded the members saying, “This important legislation will help to ensure that hospitals treating our nation’s most medically complex and vulnerable patients are not unfairly and disproportionately penalized by the Medicare Hospital Readmissions Reduction Program (HRRP).”
Established through the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152), the HRRP requires the Centers for Medicare and Medicaid Services (CMS) to penalize Inpatient Prospective Payment System (IPPS) hospitals with excess 30-day readmissions for certain conditions, starting in fiscal year (FY) 2013. The HRRP, however, does not adjust for SES factors of patient populations served by many AAMC member institutions.
Speaking to the disproportionate impact on teaching hospitals, Dr. Kirch stated, “because the current HRRP does not account for the socioeconomic status of patients served, hospitals serving the most vulnerable are dramatically more likely to incur the greatest penalties, and are the least likely to avoid penalties altogether. This means that for reasons largely beyond their control, hospitals treating the poorest patients have even fewer resources to dedicate to care coordination efforts aimed at preventing those readmissions that are avoidable.”
As part of adjusting the HRRP to account for patient SES, the legislation would create a transitional measure of SES based on a hospital’s number of Medicare/Medicaid dual eligible patients and Census Bureau data related to income, education level, and/or poverty rate; direct CMS to use findings from the SES study included in The Improving Medicare Post-Acute Care Transformation Act of 2014 to establish a long-term risk adjustment measure to ensure that hospitals serving a greater number of low-income individuals will not be unfairly penalized under the HRRP; and require the Medicare Payment Advisory Commission to submit to Congress in June 2016 a study on the appropriateness of using a 30-day threshold for readmissions within the HRRP.