If Medicare's hospital readmissions reduction program was expanded to include cardiac surgery, hospitals serving predominantly minority patient populations would bear a disproportionate amount of penalties, possibly affecting their ability to care for disadvantaged patients, concludes a study published in the June 2015 issue of Annals of Surgery. The study, which examined the readmission rates of national Medicare beneficiaries who underwent coronary artery bypass grafting between 2008 and 2010, found that when compared with non-minority-serving hospitals, minority-serving hospitals were almost twice as likely to be penalized (61% versus 32%) and were estimated to be assessed almost triple the reductions in reimbursement ($112 million versus $41 million). An accompanying editorial discusses how this program intended to improve the quality of care for all Americans could actually have devastating consequences for vulnerable patient populations. In another study related to readmissions, this one published online May 20, 2015, in Surgery, the researchers evaluated 2,797 older adults who underwent one of seven types of major cancer surgery from 2003 to 2012 and found that although readmissions did not vary by increasing age, they did vary significantly based on the type of surgery and treating hospital and were associated with the presence of more than two comorbid conditions and two or more postoperative complications. Finally, in a May 2015 statistical brief from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project characterizing Medicaid super-utilizers (those few individuals who consume the most healthcare resources), researchers found that the average all-cause 30-day readmission rate was four to eight times as high for super-utilizers as for other patients and that super-utilizers accounted for more than half of all 30-day readmissions among patients age 64 years or younger.

HRC Recommends: Readmissions are a concern for quality and safety reasons as well as financial reasons. An enterprise risk management approach to evaluating organizations' experience with readmissions can help to direct improvement efforts. Organization risk management and leadership should review the readmissions statistics and studies presented above and use them to likewise direct improvement efforts.