Large Teaching Hospitals Face More Readmission Penalties

After adjustment, likelihood of being penalized highest for safety-net hospitals

WEDNESDAY, Jan. 23 (HealthDay News) -- Large hospitals, teaching hospitals, and safety-net hospitals (SNHs) are more likely than other hospitals to be penalized under the Centers for Medicare & Medicaid Services' Hospital Readmissions Reduction Program (HRRP), according to a research letter published in the Jan. 23/30 issue of the Journal of the American Medical Association.

Karen E. Joynt, M.D., from Brigham and Women's Hospital, and Ashish K. Jha, M.D., from the Harvard School of Public Health -- both in Boston, used the HRRP Supplemental Data File to categorize hospitals as having high penalties, low penalties, and no penalties. To compare readmission penalties for the different types of hospitals, these data were linked to the 2011 American Hospital Association annual survey.

The researchers found that, as a result of the HRRP, 66.7 percent of 3,282 hospitals in the sample would receive payment cuts. High penalties would be incurred by 40 percent of large hospitals, compared with 28 percent of small hospitals. Only 24 percent of large hospitals would receive no payment cuts, compared with 47 percent of small hospitals. Major teaching hospitals were more likely to be highly penalized (44 percent) than non-teaching hospitals (33 percent) and were less likely to not be penalized (19 versus 35 percent). Forty-four percent of SNHs were likely to be highly penalized, compared with 30 percent of non-SNHs, and only 20 percent of SNHs would not be penalized. After adjustment, the likelihood of being penalized was highest for SNHs (odds ratio, 2.38).

"We found that large hospitals, teaching hospitals, and SNHs are more likely to receive payment cuts under the HRRP," the authors write.

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