Bill Would Factor Socioeconomic Risk into Hospital Readmission Rates

Rep. Jim Renacci (R-OH) introduced AHA-supported legislation (H.R. 4188) that would adjust the Medicare Hospital Readmissions Reduction Program to account for certain socioeconomic and health factors that can increase the risk of a patient’s readmission, such as being eligible for Medicaid as well as Medicare. “The bill introduced today would provide welcome relief to hospitals that are unfairly penalized by readmission penalties because they care for large numbers of poor patients, often with very complicated and multiple medical problems,” said AHA Executive Vice President Rick Pollack. “It helps ensure that hospital performance improvement efforts are focused on readmissions that are preventable.” Effective in fiscal year 2015, the bipartisan bill would require an analysis of each hospital’s dual-eligible population to ensure hospitals are not unfairly penalized for treating the most vulnerable patients; and would exclude from the program certain readmissions that are classified as transplant, end-stage renal disease, burns, trauma, psychosis or substance abuse. The legislation also would require the Department of Health and Human Services to review the program’s risk adjustment methodology to account for dual-eligible individuals, and consider using V (external cause of injury) codes to ensure hospitals are not penalized when patients are purposefully not adhering to their physician-recommended treatment. In addition, the bill would require the Medicare Payment Advisory Commission to study whether the program’s 30-day readmission threshold is appropriate. (AHA News Now – March 11, 2014)

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