The Hospital Readmission Reduction Program (HRRP) was mandated by the ACA to

reduce the number of preventable readmissions. Hospitals with excess 30-day readmissions are

penalized; CMS reduces reimbursement payments up to 3% in 2015 (American Hospital

Association (AHA), 2015). According to The Center for Health Affairs (2015), one of the

drawbacks of the HRRP is that it does not include risk adjustment for sociodemographic factors.

Hospitals that provide care to a large population of low socioeconomic statuses (SES), such as

safety net hospitals and critical access hospitals in rural areas, will be the most affected (AHA,

2015).

CMS has been reluctant to risk adjust for SES and sociodemographic factors to prevent

masking disparities in care and to hold all hospitals accountable in providing equal quality care.

However, there is a linear relationship to the factors related to a low SES population and hospital

readmissions. Furthermore, the assumption that excessive readmissions are a result of poor

quality care, rather than SES, results in HRRP penalties for hospitals that are already

disadvantaged financially (AHA, 2015; Center for Health Affairs, 2015). The current legislative

proposal is underway to place hospitals in peer groups based on low-income Medicare patients;

SES would still not be a part of the risk adjustment, but readmission benchmarking would be

varied among peer groups (Center for Health Affairs, 2015).

In a research study published in Harvard Business Review, communication between

healthcare providers and patients had the biggest impact on reducing readmissions. The study

found that when quality care processes exist, the addition of quality communication resulted in

5% point reduction in 30-day readmissions. Communication training is costly but more

affordable than the cost of re-admissions in the long run (Senot & Chandrasekaran, 2015). As

nurses, we are taught in school the importance of therapeutic communication and education for
the patient. Much of the current environment has been focused on achieving quality metrics

through competent quality care. Nurses are at the forefront in combining the communication

skills and quality care to achieve lower readmissions. The potential for a positive impact in

populations with low SES cannot be understated. This population requires the extra attention in

ensuring that they understand discharge instructions and in available resources in the outpatient

arena. Inclusion or revamping of communication skills in current nursing education is

imperative, as well as in the current work environment.

 References

American Hospital Association. (2015, March). Rethinking the hospital readmissions reduction

program. Retrieved from http://www.aha.org/research/reports/tw/15mar-tw-

readmissions.pdf

The Center for Health Affairs. (2015). Reducing hospital readmissions: An evaluation of the

federal program. Retrieved from http://www.chanet.org/TheCenterForHealthAffairs/

MediaCenter/Publications/PolicySnapshots/09-15_Hospital-Readmissions.aspx

Senot, C., & Chandrasekaran, A. (2015, September). What has the biggest impact on hospital

readmission rates. Harvard Business Review. Retrieved from

https://hbr.org/2015/09/what-has-the-biggest-impact-on-hospital-readmission-rate