Accounting For Patients' Socioeconomic Status Does Not Change Hospital Readmission Rates

Abstract

There is an active public debate about whether patients' socioeconomic status should be included in the readmission measures used to determine penalties in Medicare's Hospital Readmissions Reduction Program (HRRP). Using the current Centers for Medicare and Medicaid Services methodology, we compared risk-standardized readmission rates for hospitals caring for high and low proportions of patients of low socioeconomic status (as defined by their Medicaid status or neighborhood income). We then calculated risk-standardized readmission rates after additionally adjusting for patients' socioeconomic status. Our results demonstrate that hospitals caring for large proportions of patients of low socioeconomic status have readmission rates similar to those of other hospitals. Moreover, readmission rates calculated with and without adjustment for patients' socioeconomic status are highly correlated. Readmission rates of hospitals caring for patients of low socioeconomic status changed by approximately 0.1 percent with adjustment for patients' socioeconomic status, and only 3-4 percent fewer such hospitals reached the threshold for payment penalty in Medicare's HRRP. Overall, adjustment for socioeconomic status does not change hospital results in meaningful ways.

Keywords: Disparities; Quality Of Care; Safety-Net Systems.

EXHIBIT 3. Correlation of hospitals’ performance on risk-standardized readmission rates with and without adjustment for patients’ socioeconomic status: heart failure cohort

source Authors’ analysis of Medicare administrative claims data for hospitalizations from July 1, 2007, to June 30, 2010, and data from the 2008–12 American Community Survey. notes Colors show quintiles of hospitals’ proportion of patients of low socioeconomic status (quintile 1 hospitals have the smallest proportion of low-socioeconomic-status patients; quintile 5 hospitals have the largest proportion).