New Rules for Safety Net Hospitals Reduce Readmission Penalties, UTSW Research Shows

In order to reduce health system costs nationwide, legislation created penalties for hospitals if patients are readmitted within a certain time frame after being treated, but new research from UT Southwestern Medical Center reveals that a rule adjustment  is causing penalties to drop for hospitals that treat riskier patients.

Hospitals such as Parkland that care for socioeconomically disadvantaged patients are more likely to have patients who leave the hospital and go back to unstable environments where they can’t or don’t follow doctor’s orders closely, which can result in a return of symptoms. Patients may have transportation hurdles that keep them from properly keeping their prescription, or they may have to go back to work sooner than is advised. There are any number of social determinants that significantly impact some patients’ health more than others, meaning these hospitals suffer from higher readmission rates because of societal factors, not the care they received.

But research shows that new rules adopted in 2019 more equitably account for disadvantaged patients, and penalties have dropped 14 percent. Prior to the new rules, hospitals serving low-income populations were penalized more frequently than other hospitals by the Hospital Readmissions Reduction Program, but safety net hospitals like Parkland are now being compared to each other, rather than hospitals that don’t serve the same populations.

The new rules have reduced penalties across all hospitals from 79 percent to 75 percent, and knocked down penalties from 91 to 77 percent for safety net hospitals, especially benefitting rural, physician owned, non-teaching hospitals.

The research looked at 3,000 hospitals and analyzed the effectiveness of the new rules to help make the penalties more equitable, and it focused on four medical conditions: acute myocardial infarction (heart attack), heart failure, chronic obstructive pulmonary disease, and pneumonia.

“The more equitable distribution of penalties among these hospitals lessens the burden carried by hospitals caring for patients of low socioeconomic status,” said Dr. Pandey, Assistant Professor of Internal Medicine at UT Southwestern, senior author, and Texas Health Resources Clinical Scholar, via release.

The research, published in JAMA Open Network, was a collaboration between Brigham and Women’s Hospital, Massachusetts General Hospital, Northwestern University, and UCLA Health.