A recent study published in Health Affairs finds that some hospitals filling a safety-net role could be repeatedly penalized under the Hospital Readmissions Reduction Program (HRRP).

The study compared penalty data on 3,229 hospitals from 2013 to 2017 with hospital characteristic data and found that more than half of hospitals were penalized all five years of the program.

Repeat penalties were more likely in urban, major teaching, large, or for-profit hospitals. The penalty burden also was greater in hospitals treating a high share of Medicare beneficiaries or patients with socioeconomic disadvantages, as claims data does not account for the socioeconomic factors that cause readmissions.

The study found that although safety-net hospitals have reduced readmission rates more than other hospitals not serving a safety-net role, they struggled to improve in the HRRP. Further, the study found that most hospitals penalized early in the program struggled to improve in subsequent years.

Researchers recommended that CMS consider restructuring the program to allow more opportunities to reduce penalty burden.

America’s Essential Hospitals has been a leading advocate for risk-adjustment based on socioeconomic status for measures in Medicare quality programs to ensure that hospitals caring for vulnerable patients are not disproportionately and unfairly penalized for the challenges their patients face.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.