Beyond Adjustments for Socioeconomic Status in Hospital Readmissions Penalties

Abstract

As a hallmark of value-based payment reform, the Medicare Hospital Readmissions Reduction Program (HRRP) policy attempts to improve the quality of US health care by holding hospitals accountable for patient outcomes in the post-acute period. Specifically, it does so for medical conditions such as heart failure, pneumonia and acute myocardial infarction by financially penalizing hospitals for preventable readmissions.1 Despite laudable intentions, however, the policy has produced well-documented controversy. Some view readmission rates as a flawed measure in which patients’ socioeconomic status (SES) confounds hospital quality.2,3 Because low SES has been associated with worse disease outcomes, critics are also concerned that the HRRP unintentionally and unfairly penalizes hospitals for uncontrollable factors and caring for poor patients.4