Hospital Readmission Reduction Program Penalties for Hospitals With High Medicare Advantage Penetration.

ABSTRACT:

Importance

Since 2012, the Hospital Readmissions Reduction Program (HRRP) has penalized hospitals for excess, risk-adjusted 30 day readmissions among traditional Medicare (TM) beneficiaries. While risk adjustment may address observable differences in patient severity, it cannot account for unobservable differences. Medicare Advantage (MA) enrollment has continued to increase, and MA beneficiaries have been found to be both observably and unobservably healthier than their TM counterparts. Because relatively lower-severity patients are increasingly likely to enroll in MA, hospitals with higher MA penetration may have unobservably higher-severity TM patients, resulting in higher-than-estimated readmission risk and excessive HRRP penalties.

Objective

To determine whether unobser

SUBMITTER: Chopra Z 

PROVIDER: S-EPMC12828625 | biostudies-literature | 2026 Jan

REPOSITORIES: biostudies-literature