An Obamacare provision intended to—and succeeding at—save Medicare dollars and ensure quality of care could be hurting the safety net and teaching hospitals that disproportionately care for the sickest and poorest patients. The law reduces Medicare reimbursements for hospitals that experience high readmission rates—patients returning in the weeks after treatment. Some of these hospitals have been complaining about being unfairly targeted for the fines, and a
new study shows that they have good reason.
Researchers at Harvard Medical School found that hospitals are being penalized to a large extent based on the patients they serve. The researchers found that nearly two dozen variables, such as patients’ education, income and ability to bathe, dress and feed themselves, explain nearly half of the difference in readmission rates between the best- and worst-performing hospitals.
The worst performing hospitals, for example, have 50 percent more patients with less than a high school education than the best performers, according to the study published in JAMA Internal Medicine.
Education levels make a difference because many patients who are most likely to be readmitted to hospitals tend to have multiple chronic illnesses, such as diabetes and heart failure.
And managing those illnesses requires "a significant amount of health literacy," said Michael McWilliams, associate professor of health-care policy and medicine at Harvard Medical School, a senior author of the study.
The Hospital Readmissions Reduction Program in Medicare
does use several criteria to evaluate readmissions within 30 days—age, sex, discharge diagnosis and recent diagnoses. But the researchers at Harvard Medical School identify nearly two dozen demographic and socioeconomic factors that are associated with higher readmission rates and not considered by the Medicare program.
The consequences for some of these hospitals can be dire. The Washington Post highlights one, Franklin Medical Center in Winnsboro, Louisiana. It's a 39-bed hospital that has been hit with maximum penalty every year since 2012, because, as hospital administrator Blake Kramer explains, it serves a mostly poor population "that is not very educated. […] It was absurd and foolish for Medicare to essentially apply a one-size-fits-all penalty program and apply across every single population and every single facility," he said. "We have a lot of very elderly and very poor people."
Sen. Joe Manchin (D-WV) has re-introduced legislation that died in 2014 that would reform the the readmissions penalty. His bill isn't likely to move this session either, given a Republican Congress far more concerned with futile Obamacare repeal votes than doing anything to improve the law.