A study by researchers at Harvard Medical School says an Act intended to make hospitals more efficient is unintentionally punishing hospitals that serve the sickest, poorest and least-educated patients.
Under the ACA, hospitals face financial penalties if they have higher-than-expected rates of readmitting patients within 30 days of treating them. The study, published in the Journal of the American Medical Association, says high readmission rates often result from serving patients who are poorer, less educated and sicker than average.
The readmission penalties would be unfair if they are based on flawed criteria, the authors say. In addition, they could trigger a negative cycle of reduced payments to hospitals serving very sick patients, leaving them with fewer resources to serve those patients, resulting in lower quality of care and higher costs.
The Centers for Medicare; Medicaid and Services (CMS) adjusts each hospital’s readmission rate based mainly on the age, sex and diagnosis of the patients. The researchers looked at 29 other factors, including the educational level of patients, whether they were working, whether they smoked, and whether they suffered from depression.
The found that half of the difference in readmission rates between the best- and worst-performing hospitals were whether their patients had a high school education or higher.
During the current fiscal year, CMS will reduce reimbursements to about 2,600 hospitals by a total of $420 million.
Patients with chronic illnesses such as heart failure or diabetes are most likely to be readmitted, said Dr. Michael McWilliams, one of the study’s authors and a professor at Harvard Medical School. Managing these illnesses, he said, requires patients to have “a significant amount of health literacy,” which less-educated patients may lack.
Responding to the study, CMS said: “we will continue to work with all stakeholders to seek feasible ways to encourage hospitals to reduce hospital readmission while addressing any unintended consequences.”
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