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CMS urged to work with Congress on HRRP concerns

June 13, 2014

A bipartisan group of 34 House members June 10 urged the Centers for Medicare & Medicaid Services (CMS) to work with Congress to ensure that Medicare’s Hospital Readmissions Reduction Program is not having a negative impact on hospitals that serve low-income seniors and people with disabilities who are eligible for both Medicare and Medicaid.

“The current penalty methodology used in the HRRP has created an unintended consequence for hospitals that service our most vulnerable population – dual-eligible beneficiaries,” they told Health and Human Services Secretary Sylvia Burwell and CMS Administrator Marilyn Tavenner in a letter initiated by Rep. James Renacci, R-Ohio, citing studies that found the program’s readmission rates are tied more to community factors than hospital quality and penalize hospitals that care for the sickest and poorest Americans.

Starting Oct. 1, 2012, hospitals began getting penalized for excess readmissions. The Hospital Readmissions Reduction Program, mandated by the Affordable Care Act, cuts reimbursement rates for facilities with readmission rates above the national average. The letter noted that the payment penalty is set to increase to 3% from 2%. The lawmakers urged CMS “to work with Congress to ensure the program is not negatively impacting hospitals that service dually-eligible beneficiaries.”

The signers noted their support for the Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R. 4188), AHA-backed legislation that would require the program to account for dual-eligible beneficiaries and exclude certain readmissions to ensure hospitals are not unfairly penalized for treating the most vulnerable patients. Renacci introduced the bill in March.

For more on the letter, click on: http://tinyurl.com/q6shyoc.

The proposed inpatient prospective payment system rule for FY 2015 would add two new conditions for which hospitals would be penalized for readmissions above the national average: knee and hip replacements and chronic obstructive pulmonary disease. The three existing conditions hospitals are penalized for are heart failure, heart attack and pneumonia.

The AHA has long contended that the readmissions reduction program’s measures should be adjusted for socioeconomic factors so that hospitals caring for large numbers of poor patients do not receive excessive penalties that can reduce their ability to provide needed services to their communities.

Recent research – as the lawmakers observed in their letter to the administration – has buttressed that argument. For example, a study published in the May issue of the health policy journal Health Affairs found that adjusting for patients’ socioeconomic status reduced the variation in 30-day readmission rates across hospitals in Missouri. The study, conducted by researchers at Washington School of Medicine and BJC HealthCare in St. Louis, compared hospital performance on 30-day readmissions for Medicare heart attack, heart failure and pneumonia patients discharged between June 2009 and 2012 with results using a model enriched with patient socioeconomic data.

“We think models that do not include social factors deprive hospitals of valuable data that will help them determine how to use limited resources to help the most vulnerable patients,” said the study’s senior author William Dunagan, M.D., professor medicine and vice president of quality for BJC. For more, click on: http://tinyurl.com/ppu25cf.