Beginning in 2009, the Centers for Medicare & Medicaid Services started publicly reporting hospital readmission rates as part of the Hospital Compare website. Hospitals will begin having payments reduced if their readmission rates are higher than expected starting in fiscal year 2013. Value-based purchasing initiatives including public reporting and pay-for-performance incentives have the potential to increase quality of care. There is concern, however, that hospitals providing service to minority communities may be disproportionately penalized as a result of these policies due to higher rates of readmissions among racial and ethnic minority groups. Using 2008 Medicare data, we assess the risk for readmission for minorities and discuss implications for minority-serving institutions.
Aiken, L.H., Clarke, S.P., Sloane, D.M., Lake, E.T., & Cheney, T. ( 2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration , 38, 223-229.
2.
Alexander, M., Grumbach, K., Remy, L., Rowell, R., & Massie, B.M. ( 1999). Congestive heart failure hospitalizations and survival in California: Patterns according to race/ethnicity. American Heart Journal, 137, 919-927.
3.
Arispe, I., Holmes, J., & Moy, E. ( 2005). Measurement challenges in developing the national healthcare quality report and the national healthcare disparities report. Medical Care, 43(3).
4.
Ashton, C.M., Del Junco, D.J., Souchek, J., Wray, N.P., & Mansyur, C.L. ( 1997). The association between the quality of inpatient care and early readmission: A meta-analysis of the evidence. Medical Care, 35, 1044-1059.
5.
Averill, R.F., McCullough, E.C., Hughes, J.S., Goldfield, N.I., Vertrees, J.C., & Fuller, R.L. ( 2009). Redesigning the Medicare inpatient PPS to reduce payments to hospitals with high readmission rates. Health Care Financing Review, 30(4), 1-15.
6.
Baker, D., Stevens, C., & Brook, R. ( 1994). Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department . Journal of the American Medical Association, 271, 1909.
7.
Baker, D., Stevens, C., & Brook, R. ( 1996). Determinants of emergency department use: Are race and ethnicity important? Annals of Emergency Medicine , 28, 677-682.
8.
Balsa, A.I., & McGuire, T.G. ( 2003). Prejudice, clinical uncertainty and stereotyping as sources of health disparities. Journal of Health Economics , 22(1), 89-116.
9.
Bhalla, R., & Kalkut, G. ( 2010). Could Medicare readmission policy exacerbate health care system inequity?Annals of Internal Medicine, 152(2), 114-117.
10.
Casalino, L.P., Elster, A., Eisenberg, A., Lewis, E., Montgomery, J., & Ramos, D. ( 2007). Will pay-for-performance and quality reporting affect health care disparities? Health Affairs, 26, w405-w414.
11.
Centers for Medicare & Medicaid Services. ( 2008). Roadmap for implementing value driven healthcare in the traditional medicare fee-for-service program. Washington, DC: Center for Medicare & Medicaid Services.
12.
Chien, A.T., Chin, M.H., Davis, A.M., & Casalino, L.P. (2007). Pay for performance, public reporting, and racial disparities in health care: How are programs being designed?Medical Care Research and Review, 64(Suppl.5), 283S-304S.
13.
Coleman, E.A., Parry, C., Chalmers, S., & Min, S. ( 2006). The care transitions intervention: Results of a randomized controlled trial. Archives of Internal Medicine , 166, 1822.
14.
Curtis, L.H., Greiner, M.A., Hammill, B.G., Kramer, J.M., Whellan, D.J., Schulman, K.A., . . . Hernandez, A.F. (2008). Early and long-term outcomes of heart failure in elderly persons, 2001-2005. Archives of Internal Medicine, 168, 2481-2488.
15.
Dall, T.M., Chen, Y.J., Seifert, R.F., Maddox, P.J., & Hogan, P.F. ( 2009). The economic value of professional nursing. Medical Care, 47(1), 97-104.
16.
Deswal, A., Petersen, N.J., Souchek, J., Ashton, C.M., & Wray, N.P. ( 2004). Impact of race on health care utilization and outcomes in veterans with congestive heart failure. Journal of the American College of Cardiology, 43, 778-784.
17.
Elixhauser, A., Steiner, C., Harris, D.R., & Coffey, R.M. ( 1998). Comorbidity measures for use with administrative data . Medical Care, 36(1), 8-27.
18.
Fisher, E., & Shortell, S. ( 2010). Accountable care organizations: Accountable for what, to whom, and how. Journal of the American Medical Association , 304, 1715.
19.
Friedberg, M., Safran, D., Coltin, K., Dresser, M., & Schneider, E. ( 2010). Paying for performance in primary care: Potential impact on practices and disparities. Health Affairs, 29, 926. Friedman, B., & Basu, J. ( 2004). The rate and cost of hospital readmissions for preventable conditions. Medical Care Research and Review, 61, 225-240.
20.
Fuda, K., & Immekus, R. ( 2006). Frequent users of Massachusetts emergency departments: A statewide analysis. Annals of Emergency Medicine, 48(1), 16.
21.
Gaskin, D.J., Arbelaez, J.J., Brown, J.R., Petras, H., Wagner, F.A., & Cooper, L.A. ( 2007). Examining racial and ethnic disparities in site of usual source of care. Journal of the National Medical Association , 99(1), 22-30.
22.
Gaskin, D.J., Spencer, C.S., Richard, P., Anderson, G.F., Powe, N.R., & Laveist, T.A. ( 2008). Do hospitals provide lower-quality care to minorities than to whites? Health Affairs, 27, 518-527.
23.
Hargraves, J.L., & Hadley, J. ( 2003). The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health Services Research, 38, 809-829.
24.
Hasnain-Wynia, R., Baker, D.W., Nerenz, D., Feinglass, J., Beal, A.C., Landrum, M.B., . . . Weissman, J.S. (2007). Disparities in health care are driven by where minority patients seek care: Examination of the hospital quality alliance measures. Archives of Internal Medicine, 167, 1233-1239.
25.
Hasnain-Wynia, R., & Jean-Jacques, M. (2009). Filling the gaps between performance incentive programs and health care quality improvement. Health Services Research, 44, 777-783.
26.
Hasnain-Wynia, R., Kang, R., Landrum, M.B., Vogeli, C., Baker, D.W., & Weissman, J.S. (2010). Racial and ethnic disparities within and between hospitals for inpatient quality of care: An examination of patient-level hospital quality alliance measures. Journal of Health Care for the Poor and Underserved, 21, 629-648.
27.
Ho, K., Moy, E., & Clancy, C. ( 2010). Can incentives to improve quality reduce disparities?Health Services Research, 45(1), 1-5.
28.
Hood, R.G. ( 2007). Pay-for-performance-financial health disparities and the impact on healthcare disparities. Journal of the National Medical Association, 99, 953-958.
29.
The Hospital Quality Alliance. (2010). The hospital quality alliance: About us. Retrieved from http://www.hospitalqualityalliance.org/hospitalqualityalliance/aboutus/aboutus.html
30.
Institute of Medicine. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care . Washington, DC: National Academies Press.
31.
Institute of Medicine. (2006). Rewarding provider performance: Aligning incentives in Medicare. Washington, DC: National Academy Press .
32.
Jha, A.K., Orav, E.J., & Epstein, A.M. ( 2008). The characteristics and performance of hospitals that care for elderly Hispanic Americans. Health Affairs, 27, 528-537.
33.
Jha, A.K., Orav, E.J., Li, Z., & Epstein, A.M. ( 2007). Concentration and quality of hospitals that care for elderly black patients. Archives of Internal Medicine , 167, 1177-1182.
34.
Jiang, H.J., Andrews, R., Stryer, D., & Friedman, B. ( 2005). Racial/ ethnic disparities in potentially preventable readmissions: The case of diabetes. American Journal of Public Health, 95, 1561-1567.
35.
Kaplan, J.B., & Bennett, T. ( 2003). Use of race and ethnicity in biomedical publication . Journal of the American Medical Association, 289, 2709-2716.
36.
Kutney-Lee, A., McHugh, M.D., Sloane, D.M., Cimiotti, J.P., Flynn, L., Neff, D.F., . . . Aiken, L.H. ( 2009). Nursing: A key to patient satisfaction. Health Affairs, 28, w669-w677.
37.
LaCalle, E., & Rabin, E. ( 2010). Frequent users of emergency departments: The myths, the data, and the policy implications. Annals of Emergency Medicine , 56(1), 42-48.
38.
LaVeist, T.A. ( 1994). Beyond dummy variables and sample selection: What health services researchers ought to know about race as a variable. Health Services Research, 29(1), 1-16.
39.
Mark, B.A., Lindley, L., & Jones, C.B. ( 2009). Nurse working conditions and nursing unit costs . Policy, Politics, and Nursing Practice, 10(2), 120-128.
40.
Mayberry, R., Mili, F., & Ofili, E. ( 2000). Racial and ethnic differences in access to medical care . Medical Care Research and Review, 57(Suppl.4), 108.
41.
Medicare Payment Advisory Commission. (2007 ). Payment policy for inpatient readmissions. In Report to the Congress: Promoting greater efficiency in Medicare (pp. 103-120). Washington, DC: Author.
42.
Naylor, M.D., Brooten, D., Campbell, R., Jacobsen, B.S., Mezey, M.D., Pauly, M.V., . . . Schwartz, J.S. (1999). Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. Journal of the American Medical Association, 281, 613-620.
43.
Naylor, M.D., Brooten, D.A., Campbell, R.A., Maislin, G., McCauley, K.M., & Schwartz, J.S. (2004). Transistional care of older adults hospitalized with heart failure: A randomized, controlled trial . Journal of American Geratrics Society, 5, 675-684.
44.
Philbin, E.F., & DiSalvo, T.G. ( 1998). Influence of race and gender on care process, resource use, and hospital-based outcomes in congestive heart failure. American Journal of Cardiology, 82(1), 76-81.
45.
QualityNet. (2010). QualityNet-Readmission measures: Methodologies. Retrieved from http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic/Page/QnetTier3&cid=1219069855841
46.
Rathore, S.S., Foody, J.A.M., Wang, Y., Smith, G.L., Herrin, J., Masoudi, F.A., . . . Krumholz, H.M. (2003). Race, quality of care, and outcomes of elderly patients hospitalized with heart failure. Journal of the American Medical Association, 289, 2517.
47.
Reschovsky, J., & O’Malley, A. (2008). Do primary care physicians treating minority patients report problems delivering high-quality care? Health Affairs, 27, w222-w231.
48.
Rittenhouse, D., & Shortell, S. ( 2009). The patient-centered medical home: Will it stand the test of health reform?Journal of the American Medical Association , 301, 2038.
49.
Rosenthal, M.B., Fernandopulle, R., Song, H.R., & Landon, B. ( 2004). Paying for quality: Providers’ incentives for quality improvement. Health Affairs, 23(2), 127-141.
50.
Rothberg, M.B., Abraham, I., Lindenauer, P.K., & Rose, D.N. ( 2005). Improving nurse-to-patient staffing ratios as a cost-effective safety intervention. Medical Care, 43, 785.
51.
Ryan, A. ( 2009). Has pay-for-performance decreased access for minority patients?Health Services Research, 45(1), 6-23.
52.
SAS Institute Inc. (2008). SAS (Version 9.2). SAS Institute Inc.
53.
Schulman, K.A., Berlin, J.A., Harless, W., Kerner, J.F., Sistrunk, S., Gersh, B.J., . . . Ayers, W. ( 1999). The effect of race and sex on physicians’ recommendations for cardiac catheterization. New England Journal of Medicine , 340, 618.
54.
Sochalski, J., Jaarsma, T., Krumholz, H.M., Laramee, A., McMurray, J.J., Naylor, M.D., . . . Stewart, S. (2009). What works in chronic care management: The case of heart failure. Health Affairs, 28, 179-189.
55.
U.S. Department of Health and Human Services. ( 2007). Report to Congress: Plan to Implement a Medicare Hospital Value-Based Purchasing Program. Washington, DC: U.S. Department of Health and Human Services.
56.
van Ryn, M., & Burke, J. ( 2000). The effect of patient race and socio-economic status on physicians’ perceptions of patients. Social Science & Medicine, 50, 813-828.
57.
Werner, R.M., & Asch, D.A. ( 2005). The unintended consequences of publicly reporting quality information. Journal of the American Medical Association , 293, 1239-1244.
58.
Werner, R.M., Goldman, L.E., & Dudley, R.A. ( 2008). Comparison of change in quality of care between safety-net and non-safety-net hospitals. Journal of the American Medical Association, 299, 2180.
59.
Werner, R.M., Konetzka, R., Stuart, E., Norton, E., Polsky, D., & Park, J. ( 2009). Impact of public reporting on quality of postacute care . Health Services Research, 44, 1169-1187.
60.
Williams, D., & Rucker, T. ( 2000). Understanding and addressing racial disparities in health care. Health Care Financing Review, 21(4), 75-90.
61.
Yancy, C.W., Abraham, W.T., Albert, N.M., Clare, R., Stough, W.G., Gheorghiade, M., . . . Fonarow, G.C. ( 2008). Quality of care of and outcomes for African Americans hospitalized with heart failure: Findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) registry. Journal of the American College of Cardiology , 51, 1675-1684.
