Assessment of the Effect of Adjustment for Patient Characteristics on Hospital Readmission Rates: Implications for Pay for Performance

JAMA Internal Medicine
Eric T RobertsJ Michael McWilliams

Abstract

In several pay-for-performance programs, Medicare ties payments to readmission rates but accounts only for a limited set of patient characteristics-and no measures of social risk-when assessing performance of health care providers (clinicians, practices, hospitals, or other organizations). Debate continues over whether accounting for social risk would mitigate inappropriate penalties or would establish lower standards of care for disadvantaged patients if they are served by lower-quality providers. To assess changes in hospital performance on readmission rates after adjusting for additional clinical and social patient characteristics by using methods that distinguish the association between patient characteristics and readmission from between-hospital differences in quality. Using Medicare claims for admissions in 2013 through 2014 and linked US Census data, we assessed several clinical and social characteristics of patients that are not currently used for risk adjustment in the Hospital Readmission Reduction Program. We compared hospital readmission rates with and without adjustment for these additional characteristics, using only the average within-hospital associations between patient characteristics and readmission as the b...Continue Reading

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