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Analysis

Pressure Mounts to Risk-Adjust for Poverty

By Christopher Cheney  
   June 20, 2016

Hospital associations and trade groups are lobbying federal officials to account for how "the disease of poverty" impacts the health of patients—and costs hospitals.

The Missouri Hospital Association (MHA) is in the vanguard of a lobbying campaign to convince Congress and the Centers for Medicare & Medicaid Services to risk adjust hospital readmissions penalties for the socioeconomic and sociodemographic status of patients.

MHA has developed an augmented version of the CMS risk-adjustment model for the Hospital Readmissions Reduction Program (HRRP) to give greater weight to factors associated with a patient's economic resources and the poverty level in a patient's neighborhood.

The MHA's augmented risk-adjustment model shows that 43% to 88% of variation in quality measures between Missouri hospitals is tied to Medicaid status and the communities where patients live.

The financial stakes are high.

Last year, the 30-day readmissions penalty totaled $420 million, with the Medicare reimbursement reduction spread across 2,592 hospitals.

Pressing CMS and Congress to change the risk-adjustment model for HRRP is a top priority at MHA this year, President and CEO Herb Kuhn says.

"When we launched this effort in February, we had letters of support for our initiative from the American Hospital Association, the Association of American Medical Colleges, the Catholic Health Association, and the Federation of American Hospitals."

Since that time, "we have had a number of really good conversations with a number of our colleagues at state hospital associations across the country who are looking very aggressively at this in their own states—states like Ohio, Pennsylvania, Massachusetts, Maryland and many others."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


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