Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals.
Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals.
复制标题
医疗保险的手术再入院减少计划可能会对为少数族裔服务的医院产生不成比例的影响。
DOI：
10.1097/sla.0000000000000778
复制
发表时间：
2015
影响因子：
9
通讯作者：
Dimick,JustinB
中科院分区：
文献类型：
--
作者：
Shih,Terry;Ryan,AndrewM;Gonzalez,AndrewA;Dimick,JustinB
Objective:To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals.Background:The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown.Methods:We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N= 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non–minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles.Results:Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non–minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million).Conclusions:Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.
