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Level the Playing Field for Essential Hospitals

Medicare’s Hospital Readmissions Reduction Program (HRRP) assesses hospital quality by the rate of readmissions. But the program applies a one-size-fits-all approach that fails to account for the complex social and economic circumstances of many patients — especially those who depend on essential hospitals for care.

Simply put, many readmissions result from factors beyond a hospital’s control.

Those factors — homelessness, hunger, language barriers, transportation, and others — stand between many patients and a successful recovery. We must help them overcome these challenges. But until they do, penalizing hospitals for readmitting these patients only drains resources needed to solve the problem.

Instead, we must adjust HRRP measures for the socioeconomic status of vulnerable patients.

One approach can be found in Section 102 of The Helping Hospitals Improve Patient Care Act (H.R. 5273), which the U.S. House of Representatives has passed with bipartisan support. Section 102, or legislation like it, would level the playing field for essential hospitals so that they can continue to accept the hardest cases and deliver better health outcomes for all people, including the most vulnerable.


Most readmissions beyond the seventh day after discharge result from community- and household-level factors beyond a hospital’s control. (Health Affairs, October 2016)

Patients living in high-poverty neighborhoods were 24 percent more likely than others to be readmitted. (Health Affairs, May 2014)

Residence within a disadvantaged U.S. neighborhood is a rehospitalization predictor of magnitude similar to chronic pulmonary disease. (Annals of Internal Medicine, December 2014)

Patient characteristics not included in Medicare’s current risk-adjustment methods explain much of the difference in readmission risk between patients admitted to hospitals with higher versus lower readmission rates. (JAMA Internal Medicine, November 2015)


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Where We Stand

Our View on socioeconomic risk adjustment. view more»

Read Our Data Brief

Essential hospitals are 2.67 times more likely than other hospitals to be penalized under the HRRP. view more»

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