Nav: Home

Social risk factors and readmission penalties

March 14, 2019

DETROIT - New research shows that U.S. safety net hospitals could benefit substantially from a new model that accounts for social risk factors like poverty and living in a disadvantaged neighborhood in determining how the federal government penalizes hospitals financially for their readmission rates.

Researchers say their risk adjustment model could reduce the financial penalty for at least half of all safety net hospitals, which care for patients regardless of their insurance status or ability to pay. And in some cases, it could render them free from any penalty.

Conversely, more affluent hospitals - those that care for higher-income, better-educated patients - could see their penalty for readmission rates increase.

The study, published online in Health Services Research and due out in print in April, is certain to intensify the debate of the equity of Medicare's Hospital Readmissions Reduction Program, or HRRP. The program, administered by the Centers for Medicare and Medicaid Services, creates financial incentives for hospitals for lowering their readmission rates by penalizing those with higher rates.

Safety net hospitals have long held they are unfairly penalized for their readmission rates under HRRP's current performance model because it doesn't account for social risk factors that put these patients at risk for readmission.

"Our study shows how accounting for social risk can have a significant positive financial impact on safety net hospitals," says David Nerenz, Ph.D., the study's senior author and director emeritus of the Center for Policy and Health Services Research at Henry Ford Health System in Detroit. "And we can do so without compromising quality of care."

A commentary accompanying the study concluded that researchers provided "new evidence that incorporating social risk into risk-adjustment models may help by sparing hospitals serving the most vulnerable patients dire financial straits and perhaps even allowing them to flourish in meeting their underlying mission."

The findings demonstrate for the first time the feasibility and impact of adjusting for social factors and financial penalties for HRPP readmissions. The HRPP has been the focus of debate for its exclusion of risk adjustment for social factors since the policy's implementation in 2012. A 2016 study examining the potential impact of adding adjustment for patient income found little "meaningful change" in readmission rates, though it did not assess the financial impact of the adjustment. Under the 21st Century Cures Act, Congress now requires CMS to assign hospitals to five peer groups based on patients' Medicaid status in assessing penalties under HRPP.

Karen Joynt Maddox, M.D., MPH, the study's lead author and assistant professor of Medicine in the Cardiovascular Division at Washington University's School of Medicine in Missouri, says the study suggests that adjusting for social risk factors "has potential for leveling the playing field for hospitals that serve the most vulnerable patients."

"HRPP penalties cost safety net hospitals millions of dollars each year, but aren't a fair reflection of their performance," Dr. Maddox says. "Adding social risk factors to risk adjustment would be a significant step towards a more equitable program."

For their retrospective study, researchers analyzed claims data from nearly 3 million fee-for-service Medicare patients hospitalized for heart attack, congestive heart failure or pneumonia from December 2012 to November 2015. Their analytic approach was three-pronged:
  • Incorporated a broader group of social risk factors than analyzed in other prior research.
  • Compared hospital performance on readmissions with and without adjustment for social risk factors.
  • Calculated the financial impact of penalties levied against hospitals after adjusting for social risk factors.
Researchers found that social risk factors like poverty, disability and living in a disadvantaged neighborhood were linked with higher readmissions in all three medical conditions. However, when adjusted for social risk factors, the readmission rates for safety net hospitals dropped significantly for all three medical conditions compared to their affluent counterpart hospitals. More striking, the changes translated to a "major shift" in assessed penalties:
  • Safety net hospitals saw a 21.8 percent reduction in penalties, or roughly $17 million.
  • Affluent hospitals saw a 22 percent increase in penalties, or roughly $15 million.
Mat Reidhead, vice president of Research and Analytics at the Missouri Hospital Association and a study co-author, says the risk-adjusted model used in the study provides meaningful evidence of the magnitude of penalties levied against safety net hospitals.

"Failing to account for differences in the social complexity of patients hospitals care for has stripped significant resources away from our safety net," Reidhead says. "These are resources that could have been directed toward clinical quality improvement or upstream community health interventions. And while the recent intercession of Congress is certainly a step in the right direction, our findings suggest more can be done to ensure equity in the readmissions reduction program."
-end-
MEDIA CONTACTS: David Olejarz / David.Olejarz@hfhs.org / 313.874.4094
Diane Duke Williams / Williamsdia@wustl.edu / 314.286.0111.
Dave Dillon / ddillon@mhanet.com / 573.893.3700 ext. 1311.

Henry Ford Health System

Related Congestive Heart Failure Articles:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication
Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.
Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.
Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population
Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.
Toilet seat that detects congestive heart failure getting ready to begin commercialization
A toilet-seat based cardiovascular monitoring system created by a team of Rochester Institute of Technology researchers aims to lower the hospital readmission rates of patients with congestive heart failure.
Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.
NSAID impairs immune response in heart failure, worsens heart and kidney damage
Non-steroidal anti-inflammatory drugs, or NSAIDs, are widely known as pain-killers and can relieve pain and inflammation.
Oxygen therapy for patients suffering from a heart attack does not prevent heart failure
Oxygen therapy does not prevent the development of heart failure.
Epigenetic reprogramming of human hearts found in congestive heart failure
Congestive heart failure is a terminal disease that affects nearly 6 million Americans.
More Congestive Heart Failure News and Congestive Heart Failure Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.