The Missouri Hospital Association has published data that demonstrates that risk-adjusting Medicare readmissions based on social determinants of health reduces the readmission rates of hospitals that care for large numbers of low-income patients.

The data, modeling, and risk adjustment methodology, developed by the association based on data from Missouri hospitals, published on the association’s “Focus on Hospitals” web site, and described in an article on the NEJM Catalyst web site, showed that

SDS [note:  sociodemographic status)-enriched models yielded significant relative reductions in the range of risk-standardized readmission ratios for each of…6 outcomes…Overall, SDS enrichment best improved the 30-day readmission assessments of hospitals that served higher concentrations of Medicaid patients and higher-poverty communities.

The lack of risk adjustment for socioeconomic risk factors has been a controversial aspect of Medicare’s hospital readmissions reduction, with a growing body of research suggesting that without such risk adjustment, the program is unfair to hospitals that care for especially large numbers of low-income patients.  The National Association of Urban Hospitals has long protested the lack of risk adjustment in the readmissions reduction program and earlier this year endorsed H.R. 1343 and S. 688, both titled the Establishing Beneficiary Equity in the Hospital Readmissions Program Act, which would require the Centers for Medicare & Medicaid Services to add a risk adjustment component to the program.  See an NAUH letter endorsing the bills here.

Learn more about the work done by the Missouri Hospital Association, and its implications, in its report Risk Adjustment for Sociodemographic Status in 30-Day Hospital Readmissions and this description of and commentary on the association’s research on the NEJM Catalyst web site.