Manchin, Bipartisan Group of Senators Introduce Bill to Reform the ACA Readmissions Program
Manchin, Portman, Wicker, Kirk, Nelson, Brown introduce the Establishing Beneficiary Equity in the Hospital Readmission Program Act
Today, U.S. Senators Joe Manchin (D-WV), Rob Portman (R-OH), Roger Wicker (R-MS), Mark Kirk (R-IL), Bill Nelson (D-FL), and Sherrod Brown (D-OH) introduced the Establishing Beneficiary Equity in the Hospital Readmission Program Act, legislation to reform the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) so that hospitals serving low-income populations are evaluated and reimbursed fairly.
The Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) aims to reduce preventable readmissions by penalizing hospitals with higher-than-average Medicare readmissions rates. However, readmissions are greatly influenced by factors beyond the hospital’s control, and studies have shown that the challenges faced by urban and rural, low-income populations directly impact these outcomes. This budget-neutral bill would require the Centers for Medicare and Medicaid Services (CMS) to account for patient socio-economic status when calculating the risk-adjusted readmissions penalties. This fix would overall improve quality of care, increase accountability for all inpatient hospitals and further reduce preventable Medicare readmissions.
“We need to continue to hold our hospitals accountable for the quality of care they provide to Medicare patients, but we can’t let differences in income serve as an obstacle to improving health outcomes,” Senator Manchin said. “Hospitals serving disproportionate numbers of disadvantaged, low-income patients have higher rates of readmissions, even when those hospitals 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 the Hospital Readmissions Reduction Program immediately. Reducing avoidable hospital readmissions is extremely important, and we can only do so by aligning Medicare reimbursements with quality of care and not solely by the number of readmissions. I am thankful to work with my colleagues on both sides of the aisle on this commonsense, bipartisan bill.”
“By creating a more fair assessment of hospitals serving low-income populations, we will help to ensure that these patients have access to higher quality care,” Senator Portman said.
“Current law unfairly targets many hospitals for high readmission rates because of inadequate data,” Senator Wicker said. “Congress should level the playing field for these health-care providers, which often serve high-risk and vulnerable populations. This proposed reform is an important step toward better readmissions evaluations, ensuring that Americans continue to have access to quality health care in their communities.”
“The readmission program has been flawed from the beginning," Senator Kirk said. “Illinois medical providers should be focused on providing care instead of worrying about arbitrary penalties that prevent them from caring for those in their communities.”
“If you’re going to judge a hospital on its readmission rate, you have to take certain socioeconomic factors into account, such as whether that hospital treats more indigent and low-income people who tend to have a higher readmission rate due to a lack of consistent care,” Senator Nelson said.
“Reducing hospital readmissions is an important quality and cost-saving effort – but current rules might actually be penalizing hospitals that serve our most vulnerable patients,” Senator Brown said. “The Establishing Beneficiary Equity in the Hospital Readmission Program Act would ensure that hospitals can continue to treat the patients most in need.”
The Establishing Beneficiary Equity in the Hospital Readmission Program Act has been endorsed by the American Hospital Association, America’s Essential Hospitals, and the Association of American Medical Colleges.
“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.” - Rick Pollack, Executive Vice President, American Hospital Association
“America's Essential Hospitals thanks Sens. Manchin and Portman for their leadership and commitment to the best health care possible for all people. This legislation will ensure fairness in the readmissions reduction program and allow high-performing essential hospitals to maintain the resources they need to reduce readmissions and care disparities.” - Bruce Siegel, MD, MPH, President and CEO of America's Essential Hospitals
“The Association of American Medical Colleges (AAMC) sincerely thanks Sens. Portman and Manchin for introducing The Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. We strongly support this bipartisan legislation which would address significant challenges in the Medicare Hospital Readmissions Reduction Program (HRRP) and 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.” - Atul Grover, M.D., Ph.D., Chief Public Policy Officer at the Association of American Medical Colleges
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.
To review a one-pager on the Establishing Beneficiary Equity in the Hospital Readmission Program Act, please click here.
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