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From Health Affairs:

Safety-Net Hospitals Reduce Thirty-Day Readmission Rates But Still Lag Behind

Bethesda, MD—In 2013 the Hospital Readmissions Reduction Program (HRRP), an initiative of the Affordable Care Act (ACA), authorized the Centers for Medicare and Medicaid Services (CMS) to penalize hospitals for thirty-day readmission rates exceeding the national average.

Safety-net hospital patients, who frequently lack access to primary care and other support, have a higher chance of readmission. As a result, policy makers have called for modifications in the HRRP to remove a perceived unfair burden on safety-net hospitals. A new study, released as a Web First by Health Affairs, compared thirty-day readmission rates of safety-net hospitals and other hospitals for fiscal years 2013 and 2016. Three conditions were evaluated: heart attack, heart failure, and pneumonia. According to the study, readmission rates during that time declined more at safety-net hospitals than at other hospitals in the overall sample for each condition (see exhibit below), with heart attack readmissions declining 2.86 percentage points at safety-net hospitals, compared to 2.64 percentage points at other hospitals.

Hospital Readmissions Reduction Program: Safety-Net Hospitals Show Improvement, Modifications To Penalty Formula Still Needed

By Kathleen Carey and Meng-Yun Lin

Carey is a professor in the School of Public Health at Boston University; Lin is a research data analyst at Boston Medical Center.

This study, which was funded in part by the Agency for Healthcare Research and Quality, will also appear in the October issue of Health Affairs

The authors, who obtained their data from Medicare’s Hospital Compare website, note that while safety-net hospitals’ thirty-day readmission rates have declined at a higher rate than other hospitals, the former group had greater room for improvement. “In refining the HRRP, policy makers should bear in mind that a penalty program may not provide the best lever for incentivizing performance improvement in safety-net hospitals,” the authors concluded. “It would be advisable for CMS to pay attention to characteristics of hospitals that succeed in reducing readmissions as it modifies and expands the HRRP.”

About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print and online, with frequent Web First studies and health policy briefs published at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, it then switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the iPad app.