February 3, 2016

Contact: Dave Dillon
573/893-3700, 1311
ddillon@mhanet.com

ADJUSTMENT FOR SOCIODEMOGRAPHIC STATUS FUNDAMENTALLY ALTERS FEDERAL READMISSIONS REDUCTION PROGRAM FINDINGS

JEFFERSON CITY, Mo. — For the first time, the Missouri Hospital Association’s release of readmissions data for the state’s hospitals includes adjustment for sociodemographic status — an addition to and enrichment of the Centers for Medicare & Medicaid Services’ Readmission Reduction Program methodology. The SDS data provides a starkly contrasting view of hospitals’ readmissions, calling into question the equity of the present system. The data release was in concert with the association’s release of new quality, price and community investment data on its consumer-focused website, www.focusonhospitals.com.

“Hospitals have a responsibility to produce value,” said Herb B. Kuhn, MHA President and CEO. “At the same time, hospitals shouldn’t pay a penalty because they serve patients from economically and socially-challenged communities. Doing so only increases the chance of perpetuating disparities in access to care and health outcomes.”

Numerous organizations have identified the current risk-adjustment methodology used in the Readmission Reduction Program as inadequate in accounting for sociodemographic status when assessing hospitals for excess readmissions. The current system of penalties over-represents safety-net and some rural hospitals because it fails to account for important community-based resources, such as reliable systems for nutritious food, transitional care, social supports or transportation for follow-up visits. However, hospitals that serve patients with fewer community support systems can expect to have higher rates of readmission because an outcome like readmission can be influenced by factors independent of hospitals’ control.

The system represented in the MHA readmissions data does not disregard the CMS risk-adjustment methodology. It enriches the CMS adjustment to account for patient-level sociodemographic status factors like Medicaid eligibility and poverty, as well as risk factors attributable to patients’ communities. This more robust SDS-enhanced data produces a very different result — it significantly reduced the range of quality differences between hospitals. The MHA models suggested that 43 to 88 percent of variation in risk-adjusted readmission rates can be explained by a combination of a patient’s Medicaid status and the influence of community-level factors.

As might be expected, hospitals with the highest mix of Medicaid patients and those serving low-income communities saw the most improvement relative to the standard CMS methods. However, the SDS adjustment didn’t simply make all hospitals perform better. In many cases, readmission performance for hospitals that treat patients from high SDS communities decreased — a strong signal the approach is effective, not apologist.

Inclusion of data that fairly assesses safety-net and some rural hospitals is a widely accepted goal of the nation’s hospitals. Although this effort was MHA-specific, progress toward a better methodology for readmissions reduction — that does not unfairly penalize safety-net and some rural hospitals — is a goal embraced by the Association of American Medical Colleges, America’s Essential Hospitals, American Hospital Association, Catholic Health Association and Federation of American Hospitals.

“We believe it is time to move forward with the inclusion of SDS status, and a fairer readmission reduction risk-analysis system,” Kuhn said. “Hospitals that serve low-SDS communities are being subjected to a systematic bias that unfairly penalizes them under the current system. The penalties are imperiling care delivery to the most at-need in our communities, states and nationwide. The longer we wait, the more profound the damage will be.”

To provide the most transparent view of the power of SDS-enhanced risk-adjustment on the website, readmissions scoring for each participating hospital includes the observed readmission rate, the CMS-ratio and the CMS assessment adjusted with SDS enrichment.

“We know that posting our results won’t alter the penalties for readmission immediately,” Kuhn added. “Nonetheless, the compelling nature of the data and the methodology’s potential to inform future policy demand we shine a bright light on the differences. Too much is at stake not to show the power of the data and the extent to which a patient’s social factors can influence their health outcomes.”

Missouri Hospital Association • P.O. Box 60 • Jefferson City, MO 65102
Phone: 573-893-3700 • Fax: 573-893-2809
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