Will Hospital Peer Grouping by Patient Socioeconomic Status Fix the Medicare Hospital Readmission Reduction Program or Create New Problems? Richard L.

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Will Hospital Peer Grouping by Patient Socioeconomic Status Fix the Medicare Hospital Readmission Reduction Program or Create New Problems? Richard L. Fuller, MS, John S. Hughes, MD, Norbert I. Goldfield, MD, Richard F. Averill, MS Joint Commission Journal on Quality and Patient Safety Volume 44, Issue 4, Pages 177-185 (April 2018) DOI: 10.1016/j.jcjq.2017.10.002 Copyright © 2017 The Authors Terms and Conditions

Figure 1 Although median ERRs and penalties climb by SSI decile for the six HRRP conditions, the pattern of increase varies by condition. SSI decile 10 contains hospitals with the highest percentage shares of low-SES patients. ERR, excess readmission ratio; SSI, Supplemental Security Income; MI, myocardial infarction; COPD, chronic obstructive pulmonary disease; THKA, total hip/knee arthroplasty; CABG, coronary artery bypass graft. HRRP, Hospital Readmissions Reduction Program; low-SES, low socioeconomic status. Source: FY 2017 Final Rule HRRP Supplemental Files (Condition-Specific ERRs)24 / Disproportionate Share Hospital home page (SSI Ratios).22 Joint Commission Journal on Quality and Patient Safety 2018 44, 177-185DOI: (10.1016/j.jcjq.2017.10.002) Copyright © 2017 The Authors Terms and Conditions

Figure 2 For COPD, the median ERR for the subset of low-volume hospitals is below the peer average, while that for high-volume hospitals is above. This pattern is reversed for THKA, for which the median ERR for high-volume hospitals is above the peer average. Decile 10 contains hospitals with the highest percentage shares of low-SES patients. Note that there are only 4 hospitals in the large category in decile 10 for THKA. Low Volume: hospitals in the lowest 20% ranked by numbers of patients with the condition; High Volume: hospitals is the highest 20% by volume. ERR, excess readmissions ratio; SES, socioeconomic status; FY, fiscal year; COPD, chronic obstructive pulmonary disease; THKA, total hip/knee arthroplasty. Source: FY 2017 Final Rule HRRP Supplemental Files (Condition-Specific ERRs)24 / Disproportionate Share Hospital home page (SSI Ratios).22 Joint Commission Journal on Quality and Patient Safety 2018 44, 177-185DOI: (10.1016/j.jcjq.2017.10.002) Copyright © 2017 The Authors Terms and Conditions