Children’s hospitals receive readmission penalties for factors beyond their control

Performance-measure risk adjustment is important to hospitals because they face substantial financial penalties from readmission pay-for-performance measures.

This multicenter study examines whether risk adjustment for common social determinants of health (SDH) measures affects the readmissions-based pay-for-performance penalty status for 43 children’s hospitals.

Results showed that the hospitals are receiving financial penalties because of patients’ social determinants of health variables (ie, race, ethnicity, payer, and household income) and not because they provide poor quality of care.

Adjusting for SDH factors resulted in a change in penalty status for three hospitals within the 15-day window and five hospitals within the 30-day window.

The researchers concluded that without adjusting pay-for-performance measures for social determinants of health, hospitals may receive penalties related to patient social factors beyond the quality of hospital care.

−Sills M R, Hall M, Colvin J D, et al. Association of social determinants with children’s hospitals’ preventable readmissions performance. JAMA Pediatr. 2016;170(4):350-358.

http://archpedi.jamanetwork.com/article.aspx?articleid=2491662