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Ann Surg. 2015 Jun;261(6):1027-31. doi: 10.1097/SLA.0000000000000778.

Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals.

Author information

1
*Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI †Division of Outcomes and Effectiveness Research, Department of Public Health, Weill Cornell Medical College, New York, NY.

Abstract

OBJECTIVE:

To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals.

BACKGROUND:

The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown.

METHODS:

We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N = 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non-minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles.

RESULTS:

Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non-minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million).

CONCLUSIONS:

Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.

PMID:
24887984
PMCID:
PMC4248020
DOI:
10.1097/SLA.0000000000000778
[Indexed for MEDLINE]
Free PMC Article
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