A recent Health Affairs study finds that persistent penalties under the Hospital Readmissions Reduction Program (HRRP) could impede hospitals’ ability to meet the needs of their communities and invest in quality improvement efforts.

The HRRP aims to reduce costly and preventable hospital readmissions by penalizing hospitals with excess 30-day Medicare readmissions. Despite readmission reductions in response to the program, many experts fear that a disproportionate allocation of penalties ultimately could widen disparities in care.

Researchers found more than half of hospitals in the study received penalties all five years of the HRRP. Hospitals that were penalized more often in the first years of the program — particularly urban, major teaching, large, and safety-net hospitals — were more likely to receive penalties in all five years. The average penalty rose from 0.29 percent in 2013 to 0.60 percent this year. Medium-sized hospitals, as well as hospitals with higher proportions of Medicare patients, saw larger increases in penalties.

Overall, researchers found that hospitals serving a high proportion of socioeconomically disadvantaged patients received more penalties. In addition, safety-net hospitals were not able to improve their readmission rates at the same speed as their non–safety net counterparts.

The researchers recommend developing alternative penalty structures in the HRRP to avoid persistent penalization, while motivating reductions in hospital readmissions.