Medicare program linked with reduced readmissions disparities between black and white patients

A Medicare program that penalizes hospitals for high readmission rates was associated with a narrowing of readmission disparities between black and white patients and between minority-serving hospitals and other hospitals in the U.S., according to a new study published in Health Affairs.

The study also found that, despite the reductions in disparities, black-white gaps still persisted, and that minority-serving hospitals -- which disproportionately care for black Medicare patients --were still more likely to be penalized by the Medicare program.

Medicare's hospital readmissions reduction program was established in 2012 as part of the Affordable Care Act. Prior to its start, there was evidence that black patients had, on average, 20 percent higher readmission rates than white patients, and that hospitals serving a higher proportion of black patients had higher readmission rates than other hospitals. 

Previous evidence suggested that the readmissions reduction program may have helped lower readmission rates for all Medicare patients over time, but its impact on minority populations and the hospitals that serve them was unknown.

In the new study, Harvard Chan School researchers compared trends in 30-day readmission rates among non-Hispanic black and non-Hispanic white patients, and among minority-serving and other hospitals from 2007-2014. They analyzed national Medicare data from 6.3 million hospital admissions for patients with acute myocardial infarction, congestive heart failure, and pneumonia. Data came from 2,960 hospitals across the country, of which 283 were identified as minority-serving.

The researchers found that, prior to the HRRP, or readmissions reduction era -- from January 2007 to March 2010 -- readmission rates were relatively flat, or slightly increasing, for both white and black patients. During the HRRP implementation phase from April 2010 to September 2012, when hospitals knew that readmission penalties would soon begin, readmission rates improved both for blacks and whites, declining on average 0.45 percent per quarter for black patients and 0.36 percent per quarter for white patients. In the period after HRRP penalties were introduced, from October 2012 to December 2014, improvements in 30-day readmission rates slowed.

Overall, black patients' 30-day readmission rates fell from a high of 24.5 percent in 2010 to 18.9 percent in 2014, while white patients' rates fell from a high of 22.5 percent to 17.7 percent.

Even though minority-serving hospitals made more improvements than other hospitals, they were still more likely to be penalized because the HRRP program rewards hospitals based on their ranking relative to each other and not based on their own improvement over time, according to the study. The authors said minority-serving hospitals' lack of resources may hamper their efforts to reduce readmissions.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com