Will Hospital Peer Grouping by Patient Socioeconomic Status Fix the Medicare Hospital Readmission Reduction Program or Create New Problems?
Will Hospital Peer Grouping by Patient Socioeconomic Status Fix the Medicare Hospital Readmission Reduction Program or Create New Problems?
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DOI：
10.1016/j.jcjq.2017.10.002
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发表时间：
2018-04-01
影响因子：
2.3
通讯作者：
Averill, Richard F.
中科院分区：
文献类型：
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作者：
Fuller, Richard L.;Hughes, John S.;Averill, Richard F.
背景：2016年，美国国会指示医疗保险和医疗补助服务中心(CMS)实施21世纪治疗法案，以修复医院重新入院减少计划(HRRP)中的一个缺陷。该法案的一节旨在消除在计算医院治疗大部分低社会经济地位(SES)患者的罚款时存在的偏见。为分析引入SES医院同行组对受处罚医院的数量和分布的影响，采用2017财年CMS分析文件、HRRP最终规则和不成比例的医院份额调整对医院同行组进行分配。结果：研究结果表明，由于CMS对6种临床情况分配了单独的HRRP处罚，但建议根据所有入院情况将医院分配给单一的SES同行组，因此它将忽略这些情况下同行组中间值分布的显著差异。对于外科病例，正如预期的那样，患者较少的医院的再住院率较高，而对于内科病例，患者较少的医院再次入院的比例较低。这些发现可能会导致旨在纠正SES的同龄人组调整的扭曲。结论：医院同龄人组可能通过扭曲同龄人组的中位数而造成意外的惩罚重新分配。观察到的低容量医院和因疾病再次入院的人数减少之间的关系需要更多的研究来确立其基础。
Background: In 2016 the U.S. Congress directed the Centers for Medicare & Medicaid Services (CMS) to implement the 21st Century Cures Act to fix a flaw in the Hospital Readmissions Reduction Program (HRRP). One section of the Act is intended to remove bias in calculating penalties for hospitals treating large percentages of low socioeconomic status (SES) patients. A study was conducted to analyze the effect of the introduction of SES hospital peer groups on the number and distribution of the hospitals being penalized.Methods: The CMS analysis files for the fiscal year 2017 HRRP final rule and Disproportionate Share Hospital adjustments were used to assign hospital peer groups. The median excess readmission ratios for hospital peer groups were calculated, and the resulting pattern of hospital penalties within peer groups was analyzed.Results: The findings suggest that because CMS assigns individual HRRP penalties on six clinical conditions but proposes to assign hospitals to a single SES peer group based on all admissions, it will ignore substantial differences in the distribution of peer group medians across these conditions. For surgical cases, as expected, hospitals with fewer patients had higher readmission rates, while for medical cases, hospitals with fewer patients had fewer readmissions. These findings may result in distortion of the peer group adjustment intended to correct for SES.Conclusion: Hospital peer groups may create unintended redistributions of penalties through distortion of peer group medians. An observed relationship between lower-volume hospitals and fewer readmissions for medical conditions requires additional research to establish its basis.