WASHINGTON – U.S. Senators Roger Wicker, R-Miss., Joe Manchin, D-W.Va., Mark Kirk, R-Ill., and Bill Nelson, D-Fla., today introduced the “Hospital Readmission Accuracy and Accountability Act” to ensure that hospitals serving low-income populations are evaluated and reimbursed fairly under the Hospital Readmissions Reduction Program (HRRP).

“The Hospital Readmission Reduction Program unfairly targets many Mississippi hospitals, which serve high-risk and vulnerable populations, for high readmission rates,” Senator Wicker said. “Our bill would help protect our state’s hospitals by requiring CMS to use practical and impartial data to determine these rates going forward.”

“We must continue to hold our hospitals accountable for the quality of care they’re providing to Medicare patients, but we cannot let differences in income serve as an obstacle to improving health outcomes,” Senator Manchin said. “Hospitals serving disproportionate numbers of disadvantaged, low-income patients will have higher rates of readmissions, even when they provide high-quality, patient-focused care. Failing to recognize this reality has led to unfair penalties at many rural hospitals in West Virginia and around the country, which is why we need to reform this program immediately. Reducing avoidable hospital readmissions is extremely important, and we can only do so by aligning Medicare reimbursements with quality of care. I am thankful to work with my colleagues on both sides of the aisle on this commonsense, bipartisan bill.”

“The readmissions policy has been flawed from the beginning,” Senator Kirk said. “We need to be improving access and quality of care based on what the patient needs, not penalizing providers and patients on the basis of a one-size-fits-all government policy.”

“This is one way I think we can improve our health care system,” said Senator Bill Nelson. “If you’re going to judge a hospital on re-admissions, you should have to take into account, for example, whether it treats more folks who can't afford or don't have access to quality care after being discharged.”

This budget-neutral legislation requires the Centers for Medicare and Medicaid Services (CMS) to account for patient socio-economic status when calculating risk-adjusted readmissions penalties. Numerous studies have shown that hospitals serving large shares of low-income patients consistently have higher readmission rates than their wealthier health care institutions.

Low-income patients often lack the support to keep them out of the hospital and/or to help them become healthier due to weaker social networks, cultural and linguistic challenges, high levels of homelessness, high illiteracy rates, poor access to auxiliary health care services and pharmacies, and myriad other issues. The legislation would improve quality of care, increase accountability for all inpatient hospitals, and further reduce preventable Medicare readmissions.

This legislation is endorsed by the American Hospital Association, American Medical Association, America’s Essential Hospitals, National Association of Urban Hospitals, Association of American Medical Colleges, American College of Emergency Physicians, National Rural Health Association, National Hispanic Medical Association, and the National Hispanic Health Foundation.

Background

The Hospital Readmissions Reduction Program (HRRP) was established as a part of the Affordable Care Act in 2010 to incentivize coordination of care and reduce preventable readmissions by penalizing hospitals with higher-than-average Medicare readmissions rates. The HRRP reduces payments to hospitals with excess readmissions during the prior three years, and the program currently includes risk-adjustment for clinical factors such as comorbidities and severity of illness. In 2013, HRRP penalties were capped at 1 percent of a hospital’s inpatient base operating payments. The cap increases to 2 percent in 2014, and remains at 3 percent in 2015 and thereafter.