• Karen E Joynt Maddox, Mat Reidhead, Jianhui Hu, KindAmy J HAJHDivision of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, and Department of Veterans Affairs Geriatrics Research Education and Clinical Center, Madison, Wisconsin., Alan M Zaslavsky, Elna M Nagasako, and David R Nerenz.
• Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
• Health Serv Res. 2019 Apr 1; 54 (2): 327-336.

ObjectiveMedicare's Hospital Readmissions Reduction Program (HRRP) does not account for social risk factors in risk adjustment, and this may lead the program to unfairly penalize safety-net hospitals. Our objective was to determine the impact of adjusting for social risk factors on HRRP penalties.Study DesignRetrospective cohort study.Data Sources/Study SettingClaims data for 2 952 605 fee-for-service Medicare beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia from December 2012 to November 2015.Principal FindingsPoverty, disability, housing instability, residence in a disadvantaged neighborhood, and hospital population from a disadvantaged neighborhood were associated with higher readmission rates. Under current program specifications, safety-net hospitals had higher readmission ratios (AMI, 1.020 vs 0.986 for the most affluent hospitals; pneumonia, 1.031 vs 0.984; and CHF, 1.037 vs 0.977). Adding social factors to risk adjustment cut these differences in half. Over half the safety-net hospitals saw their penalty decline; 4-7.5 percent went from having a penalty to having no penalty. These changes translated into a $17 million reduction in penalties to safety-net hospitals.ConclusionsAccounting for social risk can have a major financial impact on safety-net hospitals. Adjustment for these factors could reduce negative unintended consequences of the HRRP.© Health Research and Educational Trust.

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