How Have 30-Day Readmission Penalties Affected Racial Disparities in Readmissions?

an Analysis from 2007 to 2014 in Five US States

Cameron Kaplan, Michael P. Thompson, Teresa Waters

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Thirty-day readmission penalties implemented with the Hospital Readmission Reduction Program (HRRP) place a larger burden on safety-net hospitals which treat a disproportionate share of racial minorities, leading to concerns that already large racial disparities in readmissions could widen. Objective: To examine whether there were changes in Black-White disparities in 30-day readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia following the passage and implementation of HRRP, and to compare disparities across safety-net and non-safety-net hospitals. Design: Repeated cross-sectional analysis, stratified by safety-net status. Subjects: 1,745,686 Medicare patients over 65 discharged alive from hospitals in 5 US states: NY, FL, NE, WA, and AR. Main Measures: Odds ratios comparing 30-day readmission rates following an index admission for AMI, CHF, or pneumonia for Black and White patients between 2007 and 2014. Key Results: Prior to the passage of HRRP in 2010, Black and White readmission rates and disparities in readmissions were decreasing. These reductions were largest at safety-net hospitals. In 2007, Blacks had 13% higher odds of readmission if treated in safety-net hospitals, compared with 5% higher odds in 2010 (P < 0.05). These trends continued following the passage of HRRP. Conclusions: Prior to HRRP, there were large reductions in Black-White disparities in readmissions at safety-net hospitals. Although HRRP tends to assess higher penalties for safety-net hospitals, improvements in readmissions have not reversed following the implementation of HRRP. In contrast, disparities continue to persist at non-safety-net hospitals which face much lower penalties.

Original languageEnglish (US)
Pages (from-to)878-883
Number of pages6
JournalJournal of General Internal Medicine
Volume34
Issue number6
DOIs
StatePublished - Jun 15 2019

Fingerprint

Patient Readmission
Safety-net Providers
Pneumonia
Heart Failure
Myocardial Infarction
Safety
Medicare
Cross-Sectional Studies
Odds Ratio
hydroquinone

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

@article{01cfa2a4b42a4886b91dcc3d2b1c7c81,
title = "How Have 30-Day Readmission Penalties Affected Racial Disparities in Readmissions?: an Analysis from 2007 to 2014 in Five US States",
abstract = "Background: Thirty-day readmission penalties implemented with the Hospital Readmission Reduction Program (HRRP) place a larger burden on safety-net hospitals which treat a disproportionate share of racial minorities, leading to concerns that already large racial disparities in readmissions could widen. Objective: To examine whether there were changes in Black-White disparities in 30-day readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia following the passage and implementation of HRRP, and to compare disparities across safety-net and non-safety-net hospitals. Design: Repeated cross-sectional analysis, stratified by safety-net status. Subjects: 1,745,686 Medicare patients over 65 discharged alive from hospitals in 5 US states: NY, FL, NE, WA, and AR. Main Measures: Odds ratios comparing 30-day readmission rates following an index admission for AMI, CHF, or pneumonia for Black and White patients between 2007 and 2014. Key Results: Prior to the passage of HRRP in 2010, Black and White readmission rates and disparities in readmissions were decreasing. These reductions were largest at safety-net hospitals. In 2007, Blacks had 13{\%} higher odds of readmission if treated in safety-net hospitals, compared with 5{\%} higher odds in 2010 (P < 0.05). These trends continued following the passage of HRRP. Conclusions: Prior to HRRP, there were large reductions in Black-White disparities in readmissions at safety-net hospitals. Although HRRP tends to assess higher penalties for safety-net hospitals, improvements in readmissions have not reversed following the implementation of HRRP. In contrast, disparities continue to persist at non-safety-net hospitals which face much lower penalties.",
author = "Cameron Kaplan and Thompson, {Michael P.} and Teresa Waters",
year = "2019",
month = "6",
day = "15",
doi = "10.1007/s11606-019-04841-x",
language = "English (US)",
volume = "34",
pages = "878--883",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "6",

}

TY - JOUR

T1 - How Have 30-Day Readmission Penalties Affected Racial Disparities in Readmissions?

T2 - an Analysis from 2007 to 2014 in Five US States

AU - Kaplan, Cameron

AU - Thompson, Michael P.

AU - Waters, Teresa

PY - 2019/6/15

Y1 - 2019/6/15

N2 - Background: Thirty-day readmission penalties implemented with the Hospital Readmission Reduction Program (HRRP) place a larger burden on safety-net hospitals which treat a disproportionate share of racial minorities, leading to concerns that already large racial disparities in readmissions could widen. Objective: To examine whether there were changes in Black-White disparities in 30-day readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia following the passage and implementation of HRRP, and to compare disparities across safety-net and non-safety-net hospitals. Design: Repeated cross-sectional analysis, stratified by safety-net status. Subjects: 1,745,686 Medicare patients over 65 discharged alive from hospitals in 5 US states: NY, FL, NE, WA, and AR. Main Measures: Odds ratios comparing 30-day readmission rates following an index admission for AMI, CHF, or pneumonia for Black and White patients between 2007 and 2014. Key Results: Prior to the passage of HRRP in 2010, Black and White readmission rates and disparities in readmissions were decreasing. These reductions were largest at safety-net hospitals. In 2007, Blacks had 13% higher odds of readmission if treated in safety-net hospitals, compared with 5% higher odds in 2010 (P < 0.05). These trends continued following the passage of HRRP. Conclusions: Prior to HRRP, there were large reductions in Black-White disparities in readmissions at safety-net hospitals. Although HRRP tends to assess higher penalties for safety-net hospitals, improvements in readmissions have not reversed following the implementation of HRRP. In contrast, disparities continue to persist at non-safety-net hospitals which face much lower penalties.

AB - Background: Thirty-day readmission penalties implemented with the Hospital Readmission Reduction Program (HRRP) place a larger burden on safety-net hospitals which treat a disproportionate share of racial minorities, leading to concerns that already large racial disparities in readmissions could widen. Objective: To examine whether there were changes in Black-White disparities in 30-day readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia following the passage and implementation of HRRP, and to compare disparities across safety-net and non-safety-net hospitals. Design: Repeated cross-sectional analysis, stratified by safety-net status. Subjects: 1,745,686 Medicare patients over 65 discharged alive from hospitals in 5 US states: NY, FL, NE, WA, and AR. Main Measures: Odds ratios comparing 30-day readmission rates following an index admission for AMI, CHF, or pneumonia for Black and White patients between 2007 and 2014. Key Results: Prior to the passage of HRRP in 2010, Black and White readmission rates and disparities in readmissions were decreasing. These reductions were largest at safety-net hospitals. In 2007, Blacks had 13% higher odds of readmission if treated in safety-net hospitals, compared with 5% higher odds in 2010 (P < 0.05). These trends continued following the passage of HRRP. Conclusions: Prior to HRRP, there were large reductions in Black-White disparities in readmissions at safety-net hospitals. Although HRRP tends to assess higher penalties for safety-net hospitals, improvements in readmissions have not reversed following the implementation of HRRP. In contrast, disparities continue to persist at non-safety-net hospitals which face much lower penalties.

UR - http://www.scopus.com/inward/record.url?scp=85061253677&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061253677&partnerID=8YFLogxK

U2 - 10.1007/s11606-019-04841-x

DO - 10.1007/s11606-019-04841-x

M3 - Article

VL - 34

SP - 878

EP - 883

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 6

ER -