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Senators Introduce Bipartisan Legislation to Amend Hospital Readmission Reduction Program

June 20, 2014— AAMC President and CEO Darrell G. Kirch, M.D., sent a June 11 letter  commending Sens. Joe Manchin (D-W.Va.), Roger Wicker (R-Miss.), Bill Nelson (D-Fla.), and Mark Kirk (R-Ill.), for introducing The Hospital Readmission Accountability and Improvement Act. The bipartisan legislation would amend the Hospital Readmission Reduction Program (HRRP) established in the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) by requiring the Centers for Medicare and Medicaid Services (CMS) to risk adjust the HRRP to account for socioeconomic status (SES) and specifically instructs the Secretary of Health and Human Services (HHS) to adjust for patient income and education status, as well as area poverty rates.

In the support letter, Dr. Kirch highlighted the AAMC’s appreciation for “the legislation’s specific instruction to the Secretary to account for patient income and education status, and area poverty rates, to the extent practicable. AAMC supports efforts to expand and refine this type of data collection to make such risk adjustment even more nuanced over time, and this legislation appropriately accounts for that evolution.”

Dr. Kirch explained the disproportionate impact of the HRRP on hospitals serving low-income populations, adding, “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 mostly beyond their control, hospitals treating the most disadvantaged patients have even fewer resources to dedicate to care coordination efforts aimed at preventing those readmissions that are avoidable.”

However, Dr. Kirch also stressed the association’s concern about a requirement that CMS publish all of the readmissions data on their website, stating, “Though the impact of socioeconomic status on hospital readmissions rates is clear, the actual methodology for risk adjustment is inherently complex. The differences between the raw data and the adjusted scores are therefore nuanced, and difficult to interpret without detailed understanding. It is for this reason that we cannot endorse the provision of your legislation that requires CMS to publish both adjusted and unadjusted data on hospital readmissions rates on its website, though we would support the dissemination of such data to researchers upon request.”

In a joint statement from the cosponsors, Sen. Manchin stated, “Hospitals serving disproportionate numbers of disadvantaged, low-income patients will have higher rates of readmissions, even when they provide high-quality, patient-focused care.” He added, “Reducing avoidable hospital readmissions is extremely important, and we can only do so by aligning Medicare reimbursements with quality of care. I am thankful to work with my colleagues on both sides of the aisle on this commonsense, bipartisan bill.”

Beginning on or after Oct. 1, 2016, the legislation would require the Secretary to risk adjust the HRRP to account for the socioeconomic status of patients served, including income, education level, poverty rate, or other factors determined appropriate by the Secretary.

Beginning in fiscal year (FY) 2018, the legislation allows for the use of an “alternative adjustment method,” such as peer groupings or stratification. However, any proposed “alternative adjustment method” must improve accuracy and validity. Additionally, prior to implementation of any “alternative adjustment method,” the Secretary is required to conduct a comparative analysis of any proposed alternatives, publish the analysis in the Federal Register, and seek public comment.


Len Marquez
Senior Director, Government Relations
Telephone: 202-862-6281


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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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Jason Kleinman
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Telephone: 202-903-0806