Jan. 21—Hospitals that treat higher shares of patients eligible for both Medicare and Medicaid coverage are more likely to incur Medicare penalties for higher rates of readmissions, a new study concluded.

The new study in Health Services Research (HSR) examined the impact of Medicare’s hospital readmissions reduction program (HRRP) on hospitals serving patient populations who qualify for Medicare because of their age and Medicaid due to their low incomes, known as dual eligibles. The study found patients’ dual-eligible status and a hospital's dual-eligible share of Medicare discharges both affected hospital readmission rates.

Authorized by the Affordable Care Act, HRRP began reducing Medicare payments to inpatient prospective payment system hospitals with excess readmissions (compared with a national average) within 30 days of a discharge for acute myocardial infarction, heart failure, and pneumonia since October, 2012.

“Under current Centers for Medicare & Medicaid Services methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals,” the HSR study authors wrote.

The factors in the risk adjustment methodology used by HRRP included patient demographics, comorbidities, and patient frailty.

The higher readmissions at hospitals with more dual-eligible patients result in disproportionately more HRRP penalties, the study found. Those Medicare payment cuts, combined the hospitals’ more likely negative all-payer margins, raised concerns of “unintended consequences,” the authors concluded.

“Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations,” the authors wrote.

The National Quality Forum (NQF) is exploring the issue of whether to considering sociodemographic factors for adjusting outcome performance measures, according to a NQF official. Adjustments could include statistical risk models or various stratification approaches. The organization expects to issue draft recommendations for comment in late February.

Publication Date: Tuesday, January 21, 2014