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A Bipartisan Solution to Protect America’s Most Vulnerable Patients | Commentary

Many of the hospitals that serve our nation’s most vulnerable populations often face a steep penalty, costing them valuable resources and ultimately hurting the very people that the penalty aims to protect: the patient.

In 2012, the Centers for Medicare and Medicaid Services established the Hospital Readmission Reduction Program to reduce acute care hospital readmissions. Hospitals with a high ratio of readmissions, based on the past three years of a hospital’s readmission data compared to the national average, are penalized under the HRRP. In the program’s first year, more than 2,200 hospitals were penalized.

We all support efforts to reduce preventable hospital readmissions. In addition to the HRRP, hospitals, clinicians, consumer and patient groups are working together through the Partnership for Patients to save lives by avoiding hospital-acquired conditions and reducing readmissions. This initiative is working to identify best practices and implement solutions to ensure all patients have the best outcome possible.

The problem with the current HRRP methodology is it assumes that if a hospital has a high proportion of patients readmitted within 30 days, it may be an indication the hospital is providing inadequate care. This is not always the case, however, as there are many factors outside of a hospital’s control that affect readmissions. In fact, there is evidence that hospitals with high mortality rates and low readmission rates fare better under the current HRRP payment methodology than hospitals with low mortality rates, but high readmission rates.

Though the HRRP program serves as an incentive in reducing avoidable rehospitalizations, it does not take into account the added difficulty in preventing readmissions among certain patient populations. Over the past two years, there has been overwhelming evidence that individuals with complex illnesses and those who are economically disadvantaged are at particularly high risk for readmission. Adherence to a treatment regime may prove difficult for disadvantaged patients due to prescription costs, challenging housing situations or difficulty obtaining their medications.

The Commonwealth Fund has found that safety-net hospitals, on average, receive higher penalties under the current methodology used by the HRRP. In fact, 77 percent of the hospitals with the highest share of low-income patients were penalized in the program’s first year. A recent study by the New England Journal of Medicine also highlighted the penalty structure’s shortfalls and urged changes stating that “HRRP will penalize hospitals that care for the sickest and the poorest Americans, largely because readmissions are driven by the severity of underlying illness and social instability at home.” Furthermore, a draft report released in March by the National Quality Forum recommended that measures of health care quality and performance be adjusted for various socioeconomic factors.

In order to ensure patients receive the best possible care, we have offered the Establishing Beneficiary Equity in the Hospital Readmission Program Act. This bipartisan bill would require the secretary of the Department of Health and Human Services to adjust the readmission penalty based on a hospital’s share of dual eligibles. It also requires the CMS to exclude certain categories of patients whose frequent hospitalizations are often clinically necessary or can be attributed to outside factors, such as the patient’s refusal or inability to comply with their physician recommended treatment. It is supported by several hospital organizations that represent inpatient facilities around the country, including the American Hospital Association, Association of American Medical Colleges, America’s Essential Hospitals and the National Association of Urban Hospitals.

It is critical that the hospitals servicing our dually eligible people have the resources available to properly meet the complex needs of their most challenging patients and are no longer unduly punished by the HRRP’s misguided penalty structure. As new evidence emerges, policies must change. HHS must make use of existing data and evidence to ensure the viability of safety-net and teaching hospitals to care for this vulnerable population.

Rep. James B. Renacci is a Republican from Ohio and serves on the Ways and Means Committee. Rep. Eliot L. Engel is a Democrat from New York and serves on the House Energy and Commerce Committee.