,,ii #aac? ,,congress #b;d ,session ,s4 #beja ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,june #ai1 #bjad ,mr4 ,man*9 7= himself1 ,mr4 ,wick]1 ,mr4 ,kirk1 & ,mr4 ,nelson7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to make improvem5ts to ! ,m$ic>e hospital readmissions r$uction program4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,hospital ,readmissions ,program ,accuracy & ,acc\ntability ,act ( #bjad4 #b4 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,elim9at+ avoidable hospital readmissions %\ld be a core t5et ( public & private ef=ts to improve quality ( c>e & r$uce heal? c>e exp5ditures4 7#b7 ,measures adopt$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %\ld accurately reflect ! quality ( c>e provid$ by specific hospitals & provid]s1 & su* measures %\ld nev] l[] outcome or quality expectations = c]ta9 cohorts ( hospitals & provid]s4 7#c7 ,!re are num]\s socioeconomic conditions t impact heal? outcomes & ! ,m$ic>e hospital readmission r$uction program is "o ( _m ,f$]al outcome p]=mance programs t fails to accurately adju/ = ^! influ5ces4 7#d7 ,hold+ all o!r factors con/ant1 socioeconomic conditions1 su* z pov]ty1 l[ levels ( lit]acy1 limit$ ,engli% pr(ici5cy1 m9imal social support1 poor liv+ conditions1 & limit$ community res\rces1 likely h direct & significant impacts on avoidable hospital readmissions4 7#e7 ,! ,m$ic>e hospital readmission r$uction program includes risk adju/m5t = cl9ical v>iables1 su* z comorbidity & sev]ity ( illness1 because hospitals %\ld n be p5aliz$ = ! effects ( ^! uncontrollable factors4 ,socioeconomic factors c influ5ce readmissions to an equal or great] degree ?an ^! cl9ical factors & ! ,m$ic>e hospital readmissions r$uction program w m accurately measure quality ( c>e once risk adju/m5t = socioeconomic /atus is implem5t$4 7#f7 ,rese>* by ! ,m$ic>e ,paym5t ,advisory ,commission1 ! ,national ,quality ,=um1 & o!r indep5d5t exp]ts has provid$ compell+ evid5ce t fail+ to adju/ = socioeconomic /atus 9 ! ,m$ic>e hospital readmission r$uction program may provide an inaccurate picture ( ! quality ( c>e provid$ by hospitals1 & has l$ to ! unfair p5alization & /igmatization ( hospitals s]v+ l[-income populations t are1 9 fact1 deliv]+ high-quality heal? c>e4 7#g7 ,risk adju/m5t = socioeconomic /atus 9 ! ,m$ic>e hospital readmission r$uction program w improve quality ( c>e1 increase acc\ntability = all inpati5t hospitals s]v+ ,m$ic>e b5efici>ies1 & fur!r r$uce prev5table readmissions nationwide4 7#h7 ,! ,secret>y ( ,heal? & ,human ,s]vices %\ld consid] ! adoption ( socioeconomic adju/m5t me?odologies 9 o!r quality report+ & pay-=-p]=mance programs "u ! ,m$ic>e program4 #c4 ,improvem5ts to ! ,m$ic>e hospital readmissions r$uction program ,section #ahhf7q7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7q77 is am5d$-- 7#a7 9 p>agraph 7#d77;,c7-- 7,a7 9 clause 7i71 9 ! matt] prec$+ subclause 7,i71 by /rik+ clause 7ii7 & ins]t+ clauses 7ii7 & 7iii72 & 7,b7 by add+ at ! end ! foll[+ new clause3 7iii7 ,adju/m5t = socioeconomic /atus 7,i7 ,9 g5]al ,9 det]m9+ a hospital's excess readmission ratio "u clause 7i7 = purposes ( mak+ paym5ts = dis*>ges occurr+ on or aft] ,octob] #a1 #bjaf1 ! ,secret>y %all risk adju/ readmissions to acc\nt = ! socioeconomic /atus ( ! pati5ts s]v$ by ! hospital4 7,,ii7 ,socioeconomic /atus ,= purposes ( subclause 7,i71 subject to subclauses 7,,iii7 & 7,v71 ! ,secret>y %all1 to ! maximum ext5t practicable1 utilize ! mo/ rec5t data available f ! ,bureau ( ! ,c5sus 9 ord] to develop a quantitative me?od to adju/ = socioeconomic /atus4 ,9 develop+ su* quantitative me?od1 ! ,secret>y-- 7aa7 %all1 to ! maximum ext5t practicable1 use inputs t address at lea/ "o ( ! foll[+ factors-- 7,,aa7 income2 7,,bb7 education level2 & 7,,cc7 pov]ty rate2 & 7bb7 may include inputs t address o!r socioeconomic & sociodemographic factors det]m9$ appropriate by ! ,secret>y4 7,,iii7 ,revision ( inputs ,! ,secret>y may revise ! inputs = su* quantitative me?od "u subclause 7,,ii7 on an annual basis to improve ! accuracy & validity ( ! adju/m5t "u subclause 7,i74 7,,iv7 ,pati5ts s]v$ by ! hospital ,= purposes ( subclause 7,i71 ! ,secret>y %all1 to ! maximum ext5t practicable1 measure ! socioeconomic /atus = all pati5ts s]v$ by ea* hospital4 ,! ,secret>y may supplem5t incomplete or inaccessible pati5t-level data ) data relat$ to ! geographic region ( ! pati5ts s]v$ by ! hospital4 7,v7 ,use ( alt]native adju/m5t me?od 7aa7 ,9 g5]al ,= purposes ( subclause 7,i71 9 ! case ( paym5ts = dis*>ges occurr+ on or aft] ,octob] #a1 #bjag1 ! ,secret>y may apply a socioeconomic /atus adju/m5t us+ a me?od o!r ?an ! me?od describ$ 9 subclause 7,,ii71 su* z pe] gr\p+s & /ratification4 7bb7 ,comp>ative analysis ,prior to ! application ( ! alt]native adju/m5t me?od "u item 7aa71 ! ,secret>y %all conduct a comp>ative analysis ( su* alt]native adju/m5t me?od & ! me?od describ$ 9 subclause 7,,ii74 ,! ,secret>y %all publi% ! results ( su* comp>ative analysis & ! propos$ alt]native adju/m5t me?od 9 ! ,f$]al ,regi/] & seek public comm5t on su* me?od4 7cc7 ,requirem5t ,! ,secret>y may n apply any alt]native adju/m5t me?od "u item 7aa7 unless ! ,secret>y det]m9es t su* alt]native me?od w demon/rate an aggregate improvem5t 9 ! accuracy & effectiv5ess ( hospital readmissions r$uction program inc5tives & measurem5ts comp>$ to ! adju/m5t requir$ "u subclause 7,i74 2 7#b7 9 p>agraph 7#f77;,a71 by add+ ! foll[+ be=e ! p]iod at ! end3 1 includ+ in=mation on ! results ( ! readmission measures "u ?is subsection 7bo? be=e & aft] ! adju/m5t "u p>agraph 7#d77;,c77iii77 & ! p5alties "u ?is subsection 7bo? be=e & aft] su* adju/m5t72 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#i7 ,adju/m5t ,! ,secret>y %all make proportional adju/m5ts to base op]at+ ,,drg paym5t am\nts 7z def9$ 9 p>agraph 7#b77 ( applicable hospitals to assure t ! application ( p>agraph 7#d77;,c77iii7 does n result 9 aggregate paym5ts "u ?is section 9 a fiscal ye> t are great] or less ?an ^? t w\ld o!rwise be made "u ?is section 9 su* fiscal ye>1 z e/imat$ by ! ,secret>y4 4