A study by researchers at Harvard Medical School says an Act intended to make hospitals more efficient is unintentionally punishing hospitals that serve the sickest, poorest and least-educated patients.
Under the, hospitals face financial if they have higher-than-expected rates readmitting patients within treating them. The study, published in the Journal the American Medical Association, says readmission rates often result from serving patients who are poorer, less educated and sicker than average.
The readmission would be unfair if they are based flawed criteria, the authors say. In addition, they could trigger a negative cycle reduced payments to hospitals serving very sick patients, leaving them with fewer resources to serve those patients, resulting in lower quality and higher costs.
The Centers for Medicare & Medicaid and Services (CMS) adjusts each hospital’s readmission rate based mainly on the age, sex and diagnosis the patients. The researchers looked at 29 other factors, including the educational level patients, whether they were working, whether they smoked, and whether they suffered from depression.
The found that half the difference in readmission rates between the best- and worst-performing hospitals was whether their patients had a school education or higher.
During the current fiscal year, CMS will reduce reimbursements to about 2,600 hospitals by a total $420 million.
Patients with chronic illnesses such as heart failure or diabetes are most likely to be readmitted, said Dr. Michael McWilliams, one the study’s authors and a professor at Harvard Medical School. Managing these illnesses, he said, requires patients to have “a significant amount of literacy,” which less-educated patients may lack.
Responding to the study, CMS said “we will continue to work with all stakeholders to seek feasible ways to encourage hospitals to reduce hospital readmission while addressing any unintended consequences.”