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Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program

Appendix Table: Variation in penalties by hospital type, 2013-2017
Hospital type % of hospitals % of Medicare patients Average hospital payment adjustment % of hospitals with any penalty % of hospitals at max penalty
2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013
(-1%)
2014
(-2%)
2015
(-3%)
2016
(-3%)
2017
(-3%)
All 100% 100% -0.27% -0.25% -0.49% -0.48% -0.58% 64% 66% 78% 78% 79% 8.0% 0.6% 1.2% 1.1% 1.8%
Rural/urban
Urban 75% 89% -0.26% -0.23% -0.46% -0.46% -0.57% 65% 66% 78% 79% 80% 7.1% 0.1% 0.8% 0.9% 1.5%
Rural 25% 11% -0.30% -0.31% -0.57% -0.51% -0.64% 62% 65% 79% 77% 77% 11.5% 1.9% 2.2% 1.7% 2.7%
Teaching status
Major teaching 9% 18% -0.43% -0.34% -0.51% -0.50% -0.66% 86% 87% 92% 92% 93% 16.5% 0.4% 3.0% 0.0% 1.0%
Other teaching 22% 37% -0.26% -0.22% -0.44% -0.45% -0.57% 68% 66% 79% 81% 84% 5.8% 0.1% 3.0% 0.4% 1.1%
nonteaching 68% 45% -0.26% -0.25% -0.50% -0.48% -0.58% 61% 63% 76% 76% 75% 8.2% 0.8% 1.5% 1.5% 2.2%
Size
<100 beds 39% 10% -0.22% -0.23% -0.45% -0.42% -0.50% 50% 53% 66% 65% 65% 7.8% 1.4% 2.3% 2.1% 2.6%
100-299 beds 42% 42% -0.30% -0.28% -0.55% -0.54% -0.67% 74% 75% 87% 86% 87% 8.2% 0.2% 0.6% 0.8% 1.6%
300+ beds 20% 49% -0.31% -0.25% -0.43% -0.45% -0.57% 71% 73% 85% 87% 90% 9.5% 0.0% 0.2% 0.0% 0.6%
Proportion of patients who are low-income, Medicare
Quartile 1 (Lowest) 24% 20% -0.18% -0.15% -0.43% -0.41% -0.47% 49% 51% 67% 66% 66% 4.3% 0.4% 1.7% 1.8% 2.3%
Quartile 2 25% 30% -0.24% -0.22% -0.46% -0.47% -0.56% 61% 62% 81% 79% 81% 5.4% 0.0% 0.2% 1.0% 1.5%
Quartile 3 25% 30% -0.31% -0.28% -0.53% -0.52% -0.64% 73% 73% 84% 85% 86% 8.0% 0.4% 1.0% 0.5% 1.1%
Quartile 4 (Highest) 25% 20% -0.37% -0.36% -0.54% -0.52% -0.69% 77% 78% 84% 85% 86% 14.7% 1.3% 1.8% 1.4% 2.5%
NOTES: The low-income Medicare patient proportion is derived from hospital ratios of Supplemental Security Income (SSI) patient days, with the 4th quartile having the highest ratio of low-income patient days. The percent of hospitals in each group is for 2016. The percent of patient admissions is from based on the March 2015 update of the FY 2014 MedPAR. Analysis excludes hospitals not subject to HRRP because they are not paid under the Medicare Hospital Inpatient Prospective Payment System (IPPS) (e.g., Maryland hospitals, psychiatric hospitals).
SOURCE: Kaiser Family Foundation analysis of CMS Final Rules and Impact Files for the Hospital IPPS; CMS’s SSI calculations are from 2014 claims run out.
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