Beschreibung:
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<jats:bold>Objective:</jats:bold>
The Affordable Care Act requires that the Centers for Medicare and Medicaid Services (CMS) reduce payments to hospitals with high readmission rates starting in 2013. Minority-serving institutions have higher rates of readmissions, and are therefore likely to be financially penalized as a result of this policy. Our objective was to better understand the characteristics, settings, and strategies that differentiate strong and poor performing minority-serving hospitals.
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<jats:bold>Methods:</jats:bold>
We conducted case studies at six U.S. hospitals with a patient population over 50% black, choosing sites based on either strong or poor performance on readmissions in 2008-2009. Chief Medical Officers, Chief Executive Officers, Chief Quality Officers, Case Managers, and other key staff at each site each participated in hour-long semi-structured interviews where questions about hospital and patient characteristics, priorities, strategies to reduce readmissions, and general impressions about CMS’s policies were asked. Detailed notes were collected and supplemented by a review of audio tapes. Themes and intensity of comments were coded and prepared as a matrix.
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<jats:bold>Results:</jats:bold>
Nearly all of the case study respondents felt that the readmission rate was an important quality metric for CMS to assess, and most respondents felt their hospitals could do better to reduce readmissions. However, few respondents knew if they were going to be penalized by CMS. The majority of respondents reported implementing new programs or procedures to try to reduce readmissions regardless of whether they were going to be penalized. Hospitals that had a low proportion of self-pay patients, high occupancy rates, and high margins had more programmatic efforts around reducing readmissions and improving transitions of care. Some strategies employed were the implementation of call centers, focused attention on discharge planning, and availability of local external resources to support program staff. Nevertheless, nearly all respondents felt that they were unable to reduce readmission rates to the level they wished because of patient and community factors, including difficulties with paying for and managing medications, literacy, housing stability, and income. Respondents also identified significant challenges in terms of infrastructure, including inadequate staffing and expertise in this area to implement potentially beneficial programs.
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<jats:bold>Conclusions:</jats:bold>
Minority-serving hospitals in our case studies faced substantial challenges to reducing readmissions, including their own financial health as well as community and patient-level factors. Better understanding the strategies and approaches that work in resource-poor settings, or accounting for the poverty of the underlying patient population, are two potential strategies for ensuring that CMS’s readmissions policies do not inadvertently worsen disparities.
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