Study: Readmissions Penalties Shift When Adjusted for Social Risk Factor

Readmissions penalties for hospitals with the greatest share of dually eligible beneficiaries could fall by an estimated $22.4 million in fiscal year 2019, while penalties for hospitals with the least share of dually eligible patients could rise by $12.3 million, according to a study reported recently in JAMA Internal Medicine. Large hospitals, teaching hospitals, hospitals in the most disadvantaged neighborhoods, and those with the highest proportion of beneficiaries with disabilities are more likely to see a reduction in penalties, as are hospitals in states with higher Medicaid eligibility cutoffs, the study found. Beginning in FY 2019, the Hospital Readmissions Reduction Program stratified hospitals based on their share of Medicare patients dually eligible for Medicaid to account for differences in the prevalence of poverty, a social risk factor associated with higher readmission rates.

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