Medicare's Hospital Readmissions Reduction Program in surgery may disproportionately affect minority-serving hospitals

Terry Shih, Andrew M. Ryan, Andrew A. Gonzalez, Justin B. Dimick

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objective: To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. Background: The Hospital Readmissions 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 observedto-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions 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.

Original languageEnglish (US)
Pages (from-to)1027-1031
Number of pages5
JournalAnnals of surgery
Volume261
Issue number6
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Patient Readmission
Medicare
Coronary Artery Bypass
Thoracic Surgery

Keywords

  • Coronary artery bypass
  • Health services research
  • Policy evaluation
  • Readmissions

ASJC Scopus subject areas

  • Surgery

Cite this

Medicare's Hospital Readmissions Reduction Program in surgery may disproportionately affect minority-serving hospitals. / Shih, Terry; Ryan, Andrew M.; Gonzalez, Andrew A.; Dimick, Justin B.

In: Annals of surgery, Vol. 261, No. 6, 01.01.2015, p. 1027-1031.

Research output: Contribution to journalArticle

Shih, Terry ; Ryan, Andrew M. ; Gonzalez, Andrew A. ; Dimick, Justin B. / Medicare's Hospital Readmissions Reduction Program in surgery may disproportionately affect minority-serving hospitals. In: Annals of surgery. 2015 ; Vol. 261, No. 6. pp. 1027-1031.
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abstract = "Objective: To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. Background: The Hospital Readmissions 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 observedto-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions 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.",
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N2 - Objective: To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. Background: The Hospital Readmissions 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 observedto-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions 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.

AB - Objective: To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. Background: The Hospital Readmissions 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 observedto-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions 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.

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