At the intersection of social ills and personal health: hospital readmission fines

The Centers for Disease Control and Prevention (CDC) has documented that social factors, like income, education, and family, have a big impact on health. Some experts estimate that these factors account for as much as 40 percent of our health.

Hospitals experience this reality every day when they care for patients struggling with socioeconomic challenges. Patients of limited means or who speak English as a second language often need different kinds of resources to achieve the best possible health results.

Even with specialized services, these patients may end up less healthy than those who have better standards of living.

Hospital readmission penalties are calling attention to the connection between social ills, personal health, and the degree to which hospitals can square this circle.

Under the federal readmission reduction program, hospitals are penalized if too many of their patients are readmitted for additional care less than 30 days after an initial hospital stay. During 2015, Pennsylvania hospitals will lose about $21 million due to these penalties.

The penalties can be a double whammy—especially for hospitals that serve communities in need.

The same socioeconomic factors that can affect health can also increase the amount (and cost) of hospital resources patients need to continue on the road to recovery, and avoid readmission, after they are discharged. According to several studies, these challenges also increase the likelihood of readmission—and of readmission penalties for the hospitals that treat them.

This chart illustrates the point.

As a result, readmission penalties siphon off dollars from the very hospitals that invest the most to help vulnerable patients stay healthy and out of the hospital in the first place. Funding for patient education, coordination of post-discharge health and social services, in-home check-ins, and other innovative programs are crucial to break the cycle of poverty, poor health, and repeated hospitalizations.

Federal policymakers have recognized this “catch 22” and are considering changes to quality measures, including the readmissions reduction program, to reflect patients’ socioeconomic backgrounds.

At-risk communities and their hospitals hope they act soon.

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Paula Bussard is Chief Strategy Officer for the Hospital & Healthsystem Association of Pennsylvania.

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