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Readmissions: Stacking the Deck

Written by: Vester Gravley on Friday, November 18, 2016 Posted in: CMS, readmission penalties, readmissions

Gentrify: To change (a place, such as an old neighborhood) by improving it and making it more appealing to people who have money.

A FierceHealthcare article (“CMS penalties may stack deck against minority-serving hospitals”), along with data showing that 72 hospitals, primarily serving the poor and elderly in rural America, have closed their doors since 2010,2[http://kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/], leads me to construe that the gentrification of the American healthcare system is perhaps one of the unintended consequences levied by CMS readmission penalties. 

The article specifically cites the results of a study led by Waddah B. Al-Refaie, M.D., chief of surgical oncology at MedStar Georgetown University Hospital, which found that while they measured “30-day readmission rates of 11.6 percent … across all the hospitals studied, the rate was higher–13.6 percent–among minority-serving hospitals.” In addition, by extending the readmission period to 90 days, the study indicates an even wider gap, with “17.4 percent of patients readmitted overall and 20.1 percent of patients readmitted at minority-serving hospitals.” By digging more deeply into the data, the researchers determined that “patient factors beyond the hospital’s control, such as income, race, and whether [the patients] were insured, comprised an increased risk of readmission of as much as 65%.”
The article does credit that CMS officials have recently recognized these limitations and are exploring how such socioeconomic factors, many of which are outside of hospital control, impact its current penalty calculation methodology. Alas, the ancient aphorism of the Roman playwright Publius Terentius Afer holds true today: “How unfair the fate which ordains that those who have the least should be always adding to the treasury of the wealthy.”