Legislators Seek to Reduce Readmission Penalties on Hospitals Treating Poor

The bill H.R. 4188, the Establishing Beneficiary Equity in the Hospital Readmission Program Act, would require the Secretary of the Department of Health and Human Services (HHS) to adjust the readmission penalty based on a hospital’s share of dual eligible patients.

Dual eligible patients include seniors and people with disabilities whose low incomes qualify them for both Medicare and Medicaid. Many hospitals have found that reducing “preventable” readmissions for these patients is more challenging because poverty is by itself a socioeconomic stress that raises readmission rates and over which hospitals have little if any control.

In addition, poor patients are more likely to lack the education and family/community support necessary to take good care of themselves after their hospital stays. They also may skip taking prescribed medications as directed if they are worried about cost, or be unable to follow medical advice about follow-up visits because they do not have a primary care provider. Care mistakes such as taking medications incorrectly are among the top reasons for readmission within 30 days of an inpatient stay.

“As a former businessman with a long record of experience in the health care industry, it is clear that the Hospital Readmission Reduction Program unfairly penalizes hospitals caring for our country’s most disadvantaged population,” stated the bill’s primary sponsor, Rep. Jim Renacci (R-Ohio). “Though the program incentivizes hospitals to reduce readmission rates, it doesn’t take into account research linking socioeconomic status to readmission penalties. Sadly, the program is inadvertently taking resources from safety-net and teaching hospitals that could be better spent helping patients avoid rehospitalization.”

Most (nine out of 15) of Rep. Renacci’s fellow Ohio congressmen and congresswomen joined him in sponsoring the bill. They were Reps. Steve Chabot (R), Bob Gibbs (R), Bill Johnson (R), David Joyce (R), Marcy Kaptur (D), Tim Ryan (D), Steve Stivers (R), Pat Tiberi (R), and Mike Turner (R).

In addition, the bill has the support of Reps. Doug LaMalfa (R-Calif.), Joe Heck (R-N.V.), Mike Kelly (R-Pa.), Michael G. Fitzpatrick (R-Pa.), Pat Meehan (R-Pa.), Scott Perry (R-Pa.), Shelley Moore Capito (R-Wash.), Sam Johnson (R-Tex.), John Carney (D-Del.), Henry C. "Hank" Johnson Jr. (D-Ga.), Eliot Engel (D-N.Y.), David Scott (D-Ga.), and Eddie Bernice Johnson (D-Tex.).

Besides reducing readmission penalties on hospitals with high numbers of dual eligible patients, the bill would provide some protection for hospitals when faced with patients that bounce back and forth between inpatient and outpatient care either because of a legitimate clinical need or because of outside factors beyond the hospitals control, such as those raised when a patient refuses to follow care recommendations and adhere to treatment plans.

The bill is supported by numerous health systems and organizations that represent hospitals, including the American Hospital Association and the Association of American Medical Colleges, and not just for financial reasons. Without protections for hospitals that treat a high percentage of poor and complex patients, the incentives that already exist to cater more to economically advantaged patient populations would only grow, supporters of the bill note.

“Passage of this legislation would ensure we are not unfairly penalized for stepping forward and serving these complex and vulnerable patients,” explained Akram Boutros,  M.D., president and CEO of the Cleveland, Ohio-based non-profit MetroHealth System, in a press release announcing the introduction of the bill. Half of MetroHealth’s patient population is eligible for both Medicare and Medicaid.