Skip to content

Date/Time: December 7th, 2022 from 10:30 am to 12:30 pm ET

Location: Zoom

Title: Antecedents and consequences of penalties imposed by the Medicare Hospital Readmissions Reduction Program and the Medicare Value Based Purchasing Program for hospitals generally and safety net hospitals in particular

Abstract: The Medicare Hospital Readmissions Reduction Program (HRRP) and the Medicare Hospital Value-Based Purchasing Program (HVBP) were established by the 2010 Patient Protection and Affordable Care Act with the aim of incentivizing hospital inpatient care quality improvement by conditioning a portion of a hospital’s reimbursement under the Medicare Inpatient Prospective Payment System on its performance, in competition with other hospitals, on select inpatient care quality metrics. Since the programs’ inception, there has been an ongoing debate among scholars and policymakers as to whether safety net hospitals (SNHs), characterized by a disproportionately large caseload of indigent and otherwise socially vulnerable patients, may be at an unfair disadvantage owing to their patients’ social risk profile. Accordingly, much attention has rightly been paid to the role of patient-level social risk in explaining variation in hospitals’ performance under these programs. Less attention, however, has been paid to the role of antecedent contextual resources at both the hospital-level (e.g., labor, capital, and technology inputs) and area-level (e.g., features of supportive healthcare infrastructure) despite the fact that, like social risk, the adequacy of the resource context within which a hospital operates might also be associated with inpatient care quality, un-evenly distributed across hospitals, and not entirely within a hospital’s control. A separate, but related, concern raised by critics of these programs has been that burdening already resource constrained hospitals (e.g., SNHs) with financial penalties could lead to or exacerbate revenue shortfalls, compelling administrators to engage in activities that are designed to alleviate the pressures imposed by the HRRP and HVBP but may nonetheless be at odds with what is in the best interest of patients and communities (e.g., reducing proportional exposure to patients who are publicly insured; cutting back on personnel; offsetting penalties with non-operating revenue that might otherwise be put toward care quality and community health initiatives). To date, the extent to which the penalties imposed by the HRRP and HVBP have had such consequences in the several years since the programs were first implemented remains unclear. The over-arching goal of my dissertation was to meaningfully contribute to ongoing discourse among scholars and policymakers regarding the experience of hospitals generally and SNHs in particular under the HRRP and HVBP by probing both of these areas of inquiry.

Committee Members: Alan Clayton-Matthews, Kristin Madison, David Cutler

Brian Ferrer Young