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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

AAMC Applauds Renacci for Establishing Beneficiary Equity in the Hospital Readmission Program Act

February 28, 2014—AAMC President and CEO, Darrell G. Kirch, M.D., sent a Feb. 24 letter  applauding Rep. Jim Renacci’s (R-Ohio) work on the Establishing Beneficiary Equity in the Hospital Readmissions Program Act, legislation that would amend the Hospital Readmission Reduction Program (HRRP) to adjust for patient disparities such as socioeconomic status (SES).

Established in 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. However, the HRRP program does not include SES risk adjustment which has resulted in a disproportionate impact on hospitals who serve vulnerable and complex patients.

Speaking to the disproportionate impact on teaching hospitals Dr. Kirch states, “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.”

Effective in FY 2015, the legislation would amend the HRRP to require SES risk adjustment that accounts for a hospital’s proportion of inpatients who are eligible for both Medicare and Medicaid benefits, also known as dual eligibles. The bill also removes certain readmissions such as transplants, end-stage renal disease, burns, trauma, psychosis, or substance abuse from consideration in order to ensure that hospitals treating the most vulnerable populations are not unfairly penalized.

The bill would require the Medicare Payment Advisory Commission to conduct a study on the appropriateness of using a 30-day threshold for readmissions, with a report due to Congress by June 2014. Finally, the bill also directs the Secretary to consider the use of V codes for potential exclusions in cases of noncompliant patients.

The legislation is expected to be introduced in early March.

Contact:

Len Marquez
Director, Government Relations
Telephone: 202-862-6281
Email: lmarquez@aamc.org

Courtney Summers
Senior Legislative Analyst
Telephone: 202-862-6042
Email: csummers@aamc.org

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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.


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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org