Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Readmission Rates: Implications for the Hospital Readmissions Reduction Program
Impact of Race/Ethnicity and Socioeconomic Status on Risk-Adjusted Readmission Rates: Implications for the Hospital Readmissions Reduction Program
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DOI：
10.1177/0046958016667596
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发表时间：
2016-10-05
影响因子：
1.7
通讯作者：
Coffey, Rosanna M.
中科院分区：
文献类型：
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作者：
Martsolf, Grant R.;Barrett, Marguerite L.;Coffey, Rosanna M.
根据医疗保险和医疗补助服务中心（CMS）的医院再入院减少计划（HRRP），因特定条件和程序而再次入院过多的医院将受到惩罚。然而，再入院率没有根据社会经济地位（SES）或种族/民族进行风险调整。我们研究了将SES和种族/民族添加到CMS风险调整算法中将如何影响医院的超额再入院率和HRRP下的潜在处罚。对于每个HRRP指标，我们比较了CMS标准风险调整算法中包含和不包含SES和种族/民族的超额再入院率，并估计了对多个医院特征的总体处罚的影响。对于5项HRRP指标（心力衰竭、急性心肌梗死、慢性阻塞性肺疾病、肺炎和全髋关节或全膝关节置换术），我们使用2011-2012年医疗保健成本和利用项目州住院患者数据库的数据计算模型中包含和不包含SES和种族/民族的超额再入院率。通过这些比率，我们估计了对HRRP处罚的影响，并发现根据SES和种族/民族进行的风险调整将影响83.8%医院的医疗保险付款。对HRRP罚款规模的影响范围为-14.4%至25.6%，但对整体医疗保险基本支付的影响很小，范围为-0.09%至0.06%。在计算中包括SES和种族/民族对安全网和农村医院有不成比例的有利影响。在HRRP风险调整计算中加入SES和种族/民族对医院和医疗保险计划的任何财务影响可能都很小。
Under the Hospital Readmissions Reduction Program (HRRP) of the Centers for Medicare & Medicaid Services (CMS), hospitals with excess readmissions for select conditions and procedures are penalized. However, readmission rates are not risk adjusted for socioeconomic status (SES) or race/ethnicity. We examined how adding SES and race/ethnicity to the CMS risk-adjustment algorithm would affect hospitals' excess readmission ratios and potential penalties under the HRRP. For each HRRP measure, we compared excess readmission ratios with and without SES and race/ethnicity included in the CMS standard risk-adjustment algorithm and estimated the resulting effects on overall penalties across a number of hospital characteristics. For the 5 HRRP measures (heart failure, acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and total hip or knee arthroplasty), we used data from the Healthcare Cost and Utilization Project's State Inpatient Databases for 2011-2012 to calculate the excess readmission ratio with and without SES and race/ethnicity included in the model. With these ratios, we estimated the impact on HRRP penalties and found that risk adjusting for SES and race/ethnicity would affect Medicare payments for 83.8% of hospitals. The effect on the size of HRRP penalties ranged from - 14.4% to 25.6%, but the impact on overall Medicare base payments was small-ranging from -0.09% to 0.06%. Including SES and race/ethnicity in the calculation had a disproportionately favorable effect on safety-net and rural hospitals. Any financial effects on hospitals and on the Medicare program of adding SES and race/ethnicity to the HRRP risk-adjustment calculation likely would be small.