Medicare readmissions policies and racial and ethnic health disparities: a cautionary tale

Abstract

Beginning in 2009, the Centers for Medicare & Medicaid Services started publicly reporting hospital readmission rates as part of the Hospital Compare website. Hospitals will begin having payments reduced if their readmission rates are higher than expected starting in fiscal year 2013. Value-based purchasing initiatives including public reporting and pay-for-performance incentives have the potential to increase quality of care. There is concern, however, that hospitals providing service to minority communities may be disproportionately penalized as a result of these policies due to higher rates of readmissions among racial and ethnic minority groups. Using 2008 Medicare data, we assess the risk for readmission for minorities and discuss implications for minority-serving institutions.

Figure 1

Thirty-day readmission (%) by race and condition Note: Asian and Pacific Islander, North American Native, and unknown race groups were combined in Other for this table due to relatively small numbers. Chi-square and corresponding p value (χ²[p]) is calculated separately for each group in reference to the White group. For heart failure: Black 63.01 (p < .001); Hispanic 9.17 (p = .002); Other 7.29 (p = .007). For acute myocardial infarction: Black 131.84 (p = .001); Hispanic 34.06 (p = .001); Other 23.23 (p = .001). For pneumonia: Black 231.90 (p < .001); Hispanic 2.65 (p = .103); Other 0.13 (p = .717).