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Research Letter
April 18, 2017

Comparative Trends in Payment Adjustments Between Safety-Net and Other Hospitals Since the Introduction of the Hospital Readmission Reduction Program and Value-Based Purchasing

Author Affiliations
  • 1Robert Wood Johnson Foundation Clinical Scholar, University of California, Los Angeles
  • 2Department of Health Management and Policy, Emory University, Atlanta, Georgia
  • 3Department of Medicine, University of California, Los Angeles
JAMA. 2017;317(15):1578-1580. doi:10.1001/jama.2017.1469

The Hospital Readmission Reduction Program (HRRP) penalizes hospitals with higher than expected 30-day readmission rates for select conditions, and Value-Based Purchasing (VBP) adjusts Medicare’s payment rate to hospitals based on a set of defined process, outcome, and experience of care measures thereby redistributing dollars collected in penalties to higher performers as bonuses.1 Because safety-net hospitals historically have higher readmission rates and lower performance on process of care and patient experience measures, there has been concern that these programs put safety-net hospitals at a financial disadvantage.2,3 Several studies have found that safety-net hospitals are more likely to be penalized under both the HRRP and VBP4,5 despite improvements in their readmission rates.6 To assess the current status of these issues, we examined trends in Medicare payment adjustments made to hospitals under these programs since fiscal year (FY) 2013, and underlying changes within different clinical condition categories in the HRRP, with a focus on hospital safety-net status.

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