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DataGen Analysis of Changes to the Readmissions Reduction Program Cited in New JAMA Study

DATE: 04/26/2019

DataGen’s financial impact modeling of sociodemographic adjustments to the Readmissions Reduction Program was used in a new JAMA study, released last week. The study, Association of Stratification by Dual Enrollment Status with Financial Penalties in the Hospital Readmissions Reduction Program,[i] examined the results of changes made by the Centers for Medicare and Medicaid (CMS) to the readmissions program last year, effective fiscal year 2019. The changes aimed to correct unfair penalties reported by safety-net hospitals due to their complex patient case mix, by separating hospitals into cohorts based on the proportion of patients in their populations who are eligible for Medicare and Medicaid.

The study’s results demonstrated that the changes were successful. Hospitals in the lowest quintile of dual eligible patients saw an increase in readmission penalties, where those in the highest quintile saw a decrease in readmission penalties. Teaching and large hospitals had higher odds of receiving a reduced penalty.

“It’s great to see that CMS’ changes are having the intended effect,” said Susan McDonough, the Senior Director at DataGen who worked with the papers’ authors to provide the financial impact model. “Programs like the Readmissions Reduction Program must continue to evolve with industry feedback, as we continue to gather and analyze data on the impact – intended and unintended – that these programs have on our healthcare system.”

[i] Association of Stratification by Dual Enrollment Status with Financial Penalties in the Hospital Readmissions Reduction Program. Karen E. Joynt Maddox, MD, MPH; Mat Reidhead, MA; Andrew C. Qi, BS; David R. Nerenz, PhD. JAMA Intern Med. doi:10.1001/jamainternmed.2019.0117. Published online April 15, 2019.


[1] Association of Stratification by Dual Enrollment Status with Financial Penalties in the Hospital Readmissions Reduction Program. Karen E. Joynt Maddox, MD, MPH; Mat Reidhead, MA; Andrew C. Qi, BS; David R. Nerenz, PhD. JAMA Intern Med. doi:10.1001/jamainternmed.2019.0117. Published online April 15, 2019.