Hospital readmissions reduction program penalizes safety net hospital clinicians

Area of Science:

• Health Services Research
• Health Disparities
• Healthcare Policy

Background:

• The Hospital Readmissions Reduction Program (HRRP) aims to improve healthcare quality and reduce costs.
• Current HRRP risk-adjustment calculations do not incorporate social determinants of health.
• This omission disproportionately affects vulnerable patient populations and can lead to unfair penalties for clinicians and hospitals.

Purpose of the Study:

• To investigate the impact of social factors on HRRP risk-adjustment calculations.
• To explore the relationship between social risk factors, healthcare disparities, and hospital penalties.
• To identify potential modifications to HRRP to mitigate unintended consequences.

Main Methods:

• A PRISMA systematic literature review was performed.
• Searched PubMed and Cochrane Library for relevant studies.
• Analyzed 15 articles published within the last 10 years focusing on social factors and HRRP.

Main Results:

• 73% of reviewed articles (11 out of 15) found that HRRP risk-adjustment calculations exacerbate healthcare disparities.
• Evidence suggests a link between the exclusion of social factors and increased disparities.

Conclusions:

• Including social risk factors in HRRP calculations could promote equitable reimbursement for hospitals serving vulnerable patients.
• Modifying HRRP is crucial to reduce negative unintended consequences and healthcare disparities.
• Further research is needed to confirm the impact of social risk factors and guide HRRP modifications.