Volume 54 | Number 2 | April 2019

Abstract List

Karen E. Joynt Maddox MD, MPH, Mat Reidhead MA, Jianhui Hu PhD, Amy J. H. Kind MD, PhD, Alan M. Zaslavsky Ph.D., Elna M. Nagasako MD, PhD, MPH, David R. Nerenz PhD


Medicare's Hospital Readmissions Reduction Program () does not account for social risk factors in risk adjustment, and this may lead the program to unfairly penalize safety‐net hospitals. Our objective was to determine the impact of adjusting for social risk factors on penalties.

Study Design

Retrospective cohort study.

Data Sources/Study Setting

Claims data for 2 952 605 fee‐for‐service Medicare beneficiaries with acute myocardial infarction (), congestive heart failure () or pneumonia from December 2012 to November 2015.

Principal Findings

Poverty, disability, housing instability, residence in a disadvantaged neighborhood, and hospital population from a disadvantaged neighborhood were associated with higher readmission rates. Under current program specifications, safety‐net hospitals had higher readmission ratios (, 1.020 vs 0.986 for the most affluent hospitals; pneumonia, 1.031 vs 0.984; and , 1.037 vs 0.977). Adding social factors to risk adjustment cut these differences in half. Over half the safety‐net hospitals saw their penalty decline; 4‐7.5 percent went from having a penalty to having no penalty. These changes translated into a $17 million reduction in penalties to safety‐net hospitals.


Accounting for social risk can have a major financial impact on safety‐net hospitals. Adjustment for these factors could reduce negative unintended consequences of the .