Congressman Jim Renacci (OH-16) and Congressman Eliot Engel (NY-16) today introduced H.R. 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act. This bipartisan, commonsense legislation requires the Secretary of the Department of Health and Human Services (HHS) to adjust the readmission penalty based on a hospital’s share of dual eligible patients, low-income seniors, or young people with a disability that are eligible for both Medicare and Medicaid. Sen. Rob Portman (R-OH) and Sen. Joe Manchin (D-WV) introduced companion legislation in the United States Senate today.
The Hospital Readmission Reduction Program (HRRP) was created under the Affordable Care Act to reduce acute care hospital readmissions by requiring the Centers for Medicare and Medicaid Services (CMS) to penalize hospitals based on the last three years of a hospital’s readmission data compared to the national average. While well-intentioned, the HRRP does not account for socio-economic factors that often have a substantial impact on readmission rates. Therefore, it disproportionately penalizes hospitals throughout the country that treat our nation’s most disadvantaged populations.
“As a former businessman with a long record of experience in the health care industry, it’s clear that the HRRP unfairly penalizes safety-net and teaching hospitals – taking valuable resources from those who are in need of them most,” said Congressman Renacci. “There is no question that this money could be better spent helping patients avoid rehospitalization. Our bill reflects that.”
Our country’s most vulnerable populations often have fewer resources available to help prevent readmissions, such as access to primary care, mental health services, rehabilitative care, transportation, prescribed medications, and food. Therefore, hospitals caring for these patients are not only more likely to incur a penalty, they are more likely to face the maximum penalty allowed under the program.
“The Establishing Beneficiary Equity in the Hospital Readmission Program Act that Rep. Renacci and I have introduced in the House, and Senators Portman and Manchin have introduced in the Senate, would make a vital correction to the HRRP hospital readmission formula, which currently treats certain hospitals in lower socioeconomic communities unfairly,” Congressman Engel said. “Hospitals must be held accountable for providing high quality care to all patients, but as numerous studies have shown, socioeconomic factors can influence patient outcomes. Therefore, hospitals serving our neediest populations shouldn’t be penalized for doing so. This is a piece of common sense legislation and I hope it passes in the House and Senate quickly.”
The Establishing Beneficiary Equity in the Hospital Readmission Program Act also requires CMS to exclude certain categories of patients whose frequent hospitalizations are often clinically necessary or can be attributed to outside factors or the patient’s refusal to comply with their physician recommended medical treatment.
Finally, this legislation requires that recommendations developed as a result of the IMPACT Act be implemented in order to fairly evaluate a hospital’s excess readmissions ratio. The IMPACT Act, which was signed into law in October 2014, requires HHS to conduct studies that examine the effect of socioeconomic status, health literacy, and English proficiency and make recommendations as to how to properly account for these factors.
Rick Pollack, executive vice president of the American Hospital Association stated, "America’s hospitals are strongly committed to reducing unnecessary readmissions, but under the Hospital Readmissions Reduction Program, some hospitals are unfairly penalized for factors beyond their control. This legislation will improve the fairness of the program and help ensure that hospitals have the critical resources they need to care for our nation’s most vulnerable patients."
"The Association of American Medical Colleges (AAMC) strongly supports the Establishing Beneficiary Equity in the Hospital Readmissions Program Act and thanks Congressman Renacci and Congressman Engel for their continued efforts to address the challenges in the Medicare Hospital Readmissions Reduction Program. This bipartisan legislation would ensure hospitals treating our nation's most medically complex and vulnerable patients are not unfairly penalized under the HRRP. It’s clear the causes of readmissions are complex, and strong evidence clearly links low socioeconomic status to higher rates of readmission. It makes little sense to penalize those hospitals caring for the sickest and poorest patients for factors that remain largely beyond their control. The AAMC remains firmly committed to reducing unnecessary re-hospitalizations and this legislation takes important steps to improve the Medicare Hospital Readmissions Reduction Program,” stated Atul Grover, M.D., Ph.D., chief public policy officer at the Association of American Medical Colleges.
Congressmen Renacci and Engel added, “It is critical that the HRRP’s unfair and misguided penalty structure is addressed so that the program no longer inadvertently takes resources from hospitals that serve low-income populations. The Establishing Beneficiary Equity in the Hospital Readmission Program Act adjusts the readmission penalty to ensure the viability of the hospitals that service our country’s poorest communities. We are proud to see broad bipartisan support for this important measure, and hope to see it move swiftly through the legislative process.”
The text of the legislation can be found here.