Are readmissions penalties fair? How community factors influence the equation

Patient Safety Monitor Insider

April 7, 2015

In October, Medicare released its third round of penalties to hospitals that readmit patients within 30 days of discharge for certain conditions. Medicare fined 2,610 hospitals, more than other previous years.

The penalties, which range from one-hundredth of a percent to 3% of each Medicare payment, are part of the Hospital Readmissions Reduction Program (HRRP) instituted by the Affordable Care Act (ACA). After its third year, some might say the program is working. After all, readmissions dropped to 19% last year, declining one percentage point compared to the previous year.

But both researchers and policy experts are calling for a reexamination of the program. These concerns revolve specifically around the fact that community factors (number of physicians and the quality of nursing homes) and patient population characteristics (income and education) may play a significant role in readmission rates.

This is an excerpt from an article in the Patient Safety Monitor Journal.

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