,,ii #aacth ,,congress #b;d ,session ,s4 #beja ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #ai1 #bjad ,mr4 ,manchin 7for himself1 ,mr4 ,wicker1 ,mr4 ,kirk1 and ,mr4 ,nelson7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to make improvements to the ,medicare hospital readmissions reduction program4 #a4 ,short title ,this ,act may be cited as the ,hospital ,readmissions ,program ,accuracy and ,accountability ,act of #bjad4 #b4 ,findings ,congress makes the following findings3 7#a7 ,eliminating avoidable hospital readmissions should be a core tenet of public and private efforts to improve quality of care and reduce health care expenditures4 7#b7 ,measures adopted by the ,centers for ,medicare ,medicaid ,services should accurately reflect the quality of care provided by specific hospitals and providers1 and such measures should never lower outcome or quality expectations for certain cohorts of hospitals and providers4 7#c7 ,there are numerous socioeconomic conditions that impact health outcomes and the ,medicare hospital readmission reduction program is one of many ,federal outcome performance programs that fails to accurately adjust for these influences4 7#d7 ,holding all other factors constant1 socioeconomic conditions1 such as poverty1 low levels of literacy1 limited ,english proficiency1 minimal social support1 poor living conditions1 and limited community resources1 likely have direct and significant impacts on avoidable hospital readmissions4 7#e7 ,the ,medicare hospital readmission reduction program includes risk adjustment for clinical variables1 such as comorbidity and severity of illness1 because hospitals should not be penalized for the effects of these uncontrollable factors4 ,socioeconomic factors can influence readmissions to an equal or greater degree than these clinical factors and the ,medicare hospital readmissions reduction program will more accurately measure quality of care once risk adjustment for socioeconomic status is implemented4 7#f7 ,research by the ,medicare ,payment ,advisory ,commission1 the ,national ,quality ,forum1 and other independent experts has provided compelling evidence that failing to adjust for socioeconomic status in the ,medicare hospital readmission reduction program may provide an inaccurate picture of the quality of care provided by hospitals1 and has led to the unfair penalization and stigmatization of hospitals serving low-income populations that are1 in fact1 delivering high-quality health care4 7#g7 ,risk adjustment for socioeconomic status in the ,medicare hospital readmission reduction program will improve quality of care1 increase accountability for all inpatient hospitals serving ,medicare beneficiaries1 and further reduce preventable readmissions nationwide4 7#h7 ,the ,secretary of ,health and ,human ,services should consider the adoption of socioeconomic adjustment methodologies in other quality reporting and pay-for-performance programs under the ,medicare program4 #c4 ,improvements to the ,medicare hospital readmissions reduction program ,section #ahhf7q7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77 is amended-- 7#a7 in paragraph 7#d77;,c7-- 7,a7 in clause 7i71 in the matter preceding subclause 7,i71 by striking clause 7ii7 and inserting clauses 7ii7 and 7iii72 and 7,b7 by adding at the end the following new clause3 7iii7 ,adjustment for socioeconomic status 7,i7 ,in general ,in determining a hospital's excess readmission ratio under clause 7i7 for purposes of making payments for discharges occurring on or after ,october #a1 #bjaf1 the ,secretary shall risk adjust readmissions to account for the socioeconomic status of the patients served by the hospital4 7,,ii7 ,socioeconomic status ,for purposes of subclause 7,i71 subject to subclauses 7,,iii7 and 7,v71 the ,secretary shall1 to the maximum extent practicable1 utilize the most recent data available from the ,bureau of the ,census in order to develop a quantitative method to adjust for socioeconomic status4 ,in developing such quantitative method1 the ,secretary-- 7aa7 shall1 to the maximum extent practicable1 use inputs that address at least one of the following factors-- 7,,aa7 income2 7,,bb7 education level2 and 7,,cc7 poverty rate2 and 7bb7 may include inputs that address other socioeconomic and sociodemographic factors determined appropriate by the ,secretary4 7,,iii7 ,revision of inputs ,the ,secretary may revise the inputs for such quantitative method under subclause 7,,ii7 on an annual basis to improve the accuracy and validity of the adjustment under subclause 7,i74 7,,iv7 ,patients served by the hospital ,for purposes of subclause 7,i71 the ,secretary shall1 to the maximum extent practicable1 measure the socioeconomic status for all patients served by each hospital4 ,the ,secretary may supplement incomplete or inaccessible patient-level data with data related to the geographic region of the patients served by the hospital4 7,v7 ,use of alternative adjustment method 7aa7 ,in general ,for purposes of subclause 7,i71 in the case of payments for discharges occurring on or after ,october #a1 #bjag1 the ,secretary may apply a socioeconomic status adjustment using a method other than the method described in subclause 7,,ii71 such as peer groupings and stratification4 7bb7 ,comparative analysis ,prior to the application of the alternative adjustment method under item 7aa71 the ,secretary shall conduct a comparative analysis of such alternative adjustment method and the method described in subclause 7,,ii74 ,the ,secretary shall publish the results of such comparative analysis and the proposed alternative adjustment method in the ,federal ,register and seek public comment on such method4 7cc7 ,requirement ,the ,secretary may not apply any alternative adjustment method under item 7aa7 unless the ,secretary determines that such alternative method will demonstrate an aggregate improvement in the accuracy and effectiveness of hospital readmissions reduction program incentives and measurements compared to the adjustment required under subclause 7,i74 2 7#b7 in paragraph 7#f77;,a71 by adding the following before the period at the end3 1 including information on the results of the readmission measures under this subsection 7both before and after the adjustment under paragraph 7#d77;,c77iii77 and the penalties under this subsection 7both before and after such adjustment72 and 7#c7 by adding at the end the following new paragraph3 7#i7 ,adjustment ,the ,secretary shall make proportional adjustments to base operating ,,drg payment amounts 7as defined in paragraph 7#b77 of applicable hospitals to assure that the application of paragraph 7#d77;,c77iii7 does not result in aggregate payments under this section in a fiscal year that are greater or less than those that would otherwise be made under this section in such fiscal year1 as estimated by the ,secretary4 4