Medicare program linked with reduced black-white disparities in hospital readmissions
- Black-white disparities in hospital readmission rates in the U.S. narrowed after the introduction of a Medicare program that penalizes higher-than-expected readmissions.
- Minority-serving hospitals continue to disproportionately receive penalties for their readmission rates, suggesting that more work needs to be done to ensure that pay-for-performance programs promote greater equity in care.
Boston, MA – A Medicare program that penalizes hospitals for high readmission rates was associated with a narrowing of readmission disparities between black and white patients and between minority-serving hospitals and other hospitals in the U.S., according to a new study from Harvard T.H. Chan School of Public Health.
The study also found that, in spite of the reductions in disparities, black-white gaps still persisted, and that minority-serving hospitals–which disproportionately care for black Medicare patients–continued to be more likely to be penalized by the Medicare program.
The study will be published April 2, 2018 in Health Affairs. After the embargo lifts, the study will be posted here: http://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1034
"It should be reassuring for policymakers that the introduction of this Medicare program was associated with a narrowing of disparities in high readmission rates between black and white patients," said lead author José Figueroa, Burke Fellow at the Harvard Global Health Institute (HGHI) and a physician at Brigham and Women's Hospital. "However, more work needs to be done since disparities persist."
Medicare's Hospital Readmissions Reduction Program (HRRP) was established in 2012 as part of the Affordable Care Act. Prior to its start, there was evidence that black patients had, on average, 20% higher readmission rates than white patients, and that hospitals serving a higher proportion of black patients had higher readmission rates than other hospitals. Previous evidence suggested that the HRRP may have helped lower readmission rates for all Medicare patients over time, but its impact on minority populations and the hospitals that serve them was unknown.
In the new study, Harvard Chan School researchers compared trends in 30-day readmission rates among non-Hispanic black and non-Hispanic white patients and among minority-serving and other hospitals from 2007-2014. They analyzed national Medicare data from 6.3 million hospital admissions for patients with acute myocardial infarction, congestive heart failure, and pneumonia. Data came from 2,960 hospitals across the country, of which 283 were identified as minority-serving.
The researchers found that, prior to the HRRP era (January 2007-March 2010), readmissions rates were relatively flat or slightly increasing for both white and black patients. During the HRRP implementation phase (April 2010-September 2012) when hospitals knew that readmission penalties would soon begin, readmission rates improved both for blacks and whites, declining on average 0.45% per quarter for black patients and 0.36% per quarter for white patients. In the period after HRRP penalties were introduced (October 2012-December 2014), improvements in 30-day readmission rates slowed.
Overall, black patients' 30-day readmission rates fell from a high of 24.5% in 2010 to 18.9% in 2014, while white patients' rates fell from a high of 22.5% to 17.7%.
Even though minority-serving hospitals made more improvements than other hospitals, they were still more likely to be penalized because the HRRP program rewards hospitals based on their ranking relative to each other and not based on their own improvement over time, according to the study. The authors speculated that minority-serving hospitals' lack of resources may hamper their efforts to reduce readmissions.
"To better incentivize and reward all hospitals, including those at the bottom, policymakers should consider changes to how penalties are determined in the HRRP," Figueroa said.
Other Harvard Chan School authors of the study included Jie Zheng, E. John Orav, Arnold Epstein, and senior author Ashish Jha.
Figueroa was partly funded by the Harvard Medical School Office for Diversity Inclusion and Community Partnership (DICP) Faculty Fellowship to conduct this work.
"Medicare Program Associated With Narrowing Hospital Readmission Disparities Between Black And White Patients," José F. Figueroa, Jie Zheng, E. John Orav, Arnold M. Epstein, and Ashish K. Jha, Health Affairs, April 2, 2018, doi: 10.1377/hlthaff.2017.1034
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Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives–not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health.