Hospitals that care for large numbers of low-income seniors are disproportionately harmed by Medicare’s hospital readmissions reduction program, according to a new study.

According to the study,

Both patient dual-eligible status and a hospital’s dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations.

The National Association of Urban Hospitals (NAUH) has long made the same argument, maintaining that Medicare’s hospital readmissions reduction program unfairly penalizes private safety-net hospitals that care for patients whose problems often go beyond medical concerns and are therefore more difficult to serve.  NAUH has conveyed these concerns to officials of the Centers for Medicare & Medicaid Services.

The study, “The Medicare Hospital Readmissions Reduction Program:  Potential Unintended Consequences for Hospitals Serving Vulnerable Populations,” was published recently in Health Services Research and can be found here.