Abstract 18187: Medicare Readmission Penalties: Worsening Cardiovascular Disease Outcome Disparities in a Low-Income Metropolitan Area?
Background: Over 2,000 hospitals will reportedly forfeit more than $280 million in Medicare funds over the next year due to readmission penalties (RP) stimulated by the Affordable Care Act. Because key factors like socioeconomic status are not accounted for, it is suspected that RPs would target many safety-net hospitals that treat low-income patients with higher readmission rates, due to poor access to follow-up and medications. Objective: To evaluate the disparities between the RPs of poorer urban/inner-city hospitals (the Detroit Metropolitan Area, DMA) in comparison with those within the state of Michigan (MI), but outside of DMA.
Methods: We analyzed the published Medicare RPs for 2013, which was based on 30-day readmission rates from 2008-2011 for congestive heart failure, pneumonia and acute myocardial infarction, attributing penalties ranging from 0 to 1% of all Medicare payments for 2013. We removed data from hospitals known to not serve patients with these illnesses (i.e., surgical or dedicated cancer hospitals).
Results: Out of the 93 hospitals in the state of MI fitting these criteria, 5 were within the city of Detroit, 12 within the Detroit Medicare Region and 17 within the Detroit/Dearborn Region, which serves a similar population. No RP (0%) was given to 45 of 76 non-DMA hospitals, but to none of the 17 DMA hospitals (p < 0.0001). The maximum penalty (1%) was received by 29% of DMA hospitals, compared with 22% of non-DMA hospitals. The average penalty in the DMA hospitals was 0.68%, but only 0.15% in non-DMA MI hospitals (p < 0.001).
Conclusion: RPs reduce Medicare payments to inner-city hospitals more than other hospitals in the state of MI. This may have the unintended consequence of further reducing access care from safety-net hospitals due to a) lack of funding for programs that can reduce recurrent illness post-discharge, b) incentives to stiffen criteria for admission to patients needing care, or c) resulting hospital closures.
- © 2013 by American Heart Association, Inc.