Equity-Efficiency Tradeoff: The Hospital Readmissions Reduction Program and Disparities in Outcomes among Vulnerable Medicare Heart Failure Patients in Pennsylvania

Abstract

The Hospital Readmissions Reduction Program (HRRP), a penalty-based pay for performance policy mandated by the 2010 Affordable Care Act, aims to improve health care quality for seniors and cut costs by avoiding readmissions but may disproportionally affect disadvantaged populations. Our study using patient-level survival analysis of data on outcomes for Medicare beneficiaries age 65 years and older who were discharged with heart failure from Pennsylvania inpatient prospective payment systems hospitals from 2010 to 2015, confirm that risk -adjusted readmissions have decreased but the likelihood of mortality has increased for some patients. Non-White heart patients and those living in lower income areas had higher risk of readmission within 30-day and one-year of discharge. Patients living in lower income areas also had a higher risk of mortality than those in more affluent communities. Findings suggest unintended consequences and the need for policy makers and administrators to address the social determinants of health.