Skip Navigation LinksHome > Published Ahead-of-Print > Medicare's Hospital Readmission Reduction Program in Surgery...
Annals of Surgery:
doi: 10.1097/SLA.0000000000000778
Original Article: PDF Only

Medicare's Hospital Readmission Reduction Program in Surgery May Disproportionately Affect Minority-Serving Hospitals.

Shih, Terry MD; Ryan, Andrew M. PhD; Gonzalez, Andrew A. MD, JD, MPH; Dimick, Justin B. MD, MPH

Published Ahead-of-Print
Collapse Box

Abstract

Objective: To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals.

Background: The Hospital Readmission 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 Readmission 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.

(C) 2014 by Lippincott Williams & Wilkins.

Login

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.