Safety Net Hospitals Face Disadvantages Under 30-Day Readmission Program

30-day readmission penalties may unfairly impact safety net hospitals because those facilities tend to care for more patients with socio-economic challenges, according to researchers and health policy analysts.


Earlier this year, the National Quality Forum (NQF) issued a draft report where it noted: “failing to adjust performance measures for socio-demographic factors could produce incorrect conclusions about quality.” It announced last week that it plans to undertake a “robust” trial to study the impact of socio-demographic factors on 30-day hospital readmissions. The trial will examine factors such as income, education, race and primary language. Details about the trial duration and specific measures are forthcoming. (“NQF to study socio-demographic factors in 30-day readmissions,” Modern Healthcare, July 24, 2014)


Another recent study found race, unemployment  and poverty among the elderly were particularly strong predictors of higher readmission rates. Truven Health Analytics reviewed CMS data from more than 2,225 hospitals that had been penalized for 30-day readmissions through October 2013.


And Health Affairs published a study in May that found that patients living in high-poverty neighborhoods in Detroit were 24% more like to be readmitted to the hospital. (The study looked specifically at readmission rates at Henry Ford Health System.)


CMS Response


CMS maintains its commitment to ensure that hospitals serving disadvantaged populations are not unfairly penalized, but it has found that safety net hospitals can and do perform well on readmissions measures, according to an agency statement. It noted in its statement that association between certain socio-demographic factors and health outcomes can be due, in part, to differences in the quality of the healthcare received. “Adjustment for these factors could confound the results,” the agency added. (“Safety net hospitals face socio-economic disadvantages,” Modern Healthcare, June 7, 2014)


Though it acknowledges the complexities of the issue, the CMS contends that hospitals can influence some of the socio-economic factors in their communities. “The scope of activities that fall within a hospital’s control is wider than it may seem, giving hospitals a range of opportunity to influence readmission rates in their community.” (“Safety net hospitals face socio-economic disadvantages,” Modern Healthcare, June 7, 2014)




As a result of a provision of the Affordable Care Act (ACA) the Centers for Medicare and Medicaid Services (CMS) is required to reduce payments to hospitals with “excess readmissions.” Currently, conditions affected by the 30-day readmission policy are acute myocardial infarction, heart failure and pneumonia. (Readmissions Reduction Program,




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