AAMC Statement on the introduction of the Establishing Beneficiary
Equity in the Hospital Readmission Program Act of 2015
To GRRs:
As you know, the Affordable Care Act established the Medicare Hospital
Readmission Reduction Program (HRRP) penalizing IPPS hospitals with
excess 30-day readmissions for certain conditions, starting in FY
2013. The disproportionate impact of the readmissions penalties on
safety net hospitals has been well documented: hospitals serving
low-income populations are dramatically more likely to incur the
greatest penalties and are the least likely to avoid penalties
altogether. There is no risk-adjustment currently in the HRRP to
account for socioeconomic status – of the patient or of the population
of patients served by a hospital.
On Tuesday, March 10, Rep. Jim Renacci (R-OH), Rep. Eliot Engel
(D-NY), Sen. Rob Portman (R-OH), and Sen. Joe Manchin (D-WV)
introduced the Establishing Beneficiary Equity in the Hospital
Readmission Program Act of 2015.
The Establishing Beneficiary Equity in the Hospital Readmission
Program Act of 2015:
Amends the HRRP to require that the Secretary take into account the
socioeconomic status of patients when determining a hospital’s excess
readmission ratio under the Hospital Readmissions Reduction Program.
Creates a transitional measure of patient socioeconomic status
comprised of 1) the number of Medicare/Medicaid dual eligible patients
the hospital serves and 2) Census Bureau data related to income,
education level, and/or poverty rate.
Following the completion of the socioeconomic status study required by
the IMPACT Act (passed in 2014), requires CMS to use the findings to
establish a risk adjustment measure to ensure that hospitals serving a
greater number of low-income individuals will not be unfairly
penalized under the HRRP.
Requires MedPAC to submit to Congress in June 2016 a study on the
appropriateness of using a 30-day threshold for readmissions within
HRRP.
Requires an HHS study, including input from a technical expert panel,
on excluding certain clinical conditions that may require frequent
hospitalization from the calculation of excess readmissions. Requires
the Secretary to apply the findings of the study to the calculation of
a hospital’s excess readmission ratio.
Authorizes Secretary to permit use of V codes (or the ICD-10
equivalent) for potential exclusions of cases of non-compliant cases.
Requires that the bill be implemented in a budget neutral manner.
Directs Secretary not to impose additional reporting requirements on hospitals.
The AAMC strongly supports the Establishing Beneficiary Equity in the
Hospitals Readmissions Program Act, and we encourage you to contact
your state delegations and ask them to cosponsor the legislation. To
cosponsor, Members can contact Patrick Velliky
(
patrick.velliky@mail.house.gov) with Rep. Renacci, Heidi Ross
(
heidi.ross@mail.house.gov) with Rep. Engel, Sarah Johnson
(
sarah_johnson@portman.senate.gov) with Sen. Portman, or Katherine
Cassling (
katherine_cassling@manchin.senate.gov) with Sen. Manchin.
