AHA Urges Changes to Readmissions Risk-Adjustment Methodology

The AHA urged the Centers for Medicare & Medicaid Services to include additional patient characteristics such as race and limited English proficiency in its risk-adjustment methodology for the Hospital Readmissions Reduction Program to ensure that it complies with Title VI of the Civil Rights Act of 1964. The act provides that "[n]o person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”

In the letter, AHA notes that the Supreme Court has recognized that an agency may promulgate more expansive regulations that prohibit disparate-impact discrimination. Such discrimination “is the probable result of the implementation of an HRRP program that fails to take into account the racial and ethnic composition of the participating hospitals' patient populations,” AHA said. “It is therefore necessary to incorporate this factor into the HRRP's risk-adjustment methodology. Otherwise, the program may run afoul of both [regulation] and the congressional policy of non-discrimination in federal programs underlying Title VI.” Required by the Patient Protection and Affordable Care Act, the HRRP would reduce Medicare payments to hospitals with higher than expected readmission rates beginning in fiscal year 2013.

06-20-2011 07:09 (EDT)