This past year we have seen a lot of media attention brought to both healthcare, amidst the current pandemic, as well as systemic racism, triggered from police brutality. All throughout the country we’ve seen Black Lives Matter protests bringing attention to the disparities and racism that Black people and all people of color face in America.
We see this presented in the healthcare field now more than ever. Recently in the news was the tragic passing of Indiana doctor, Susan Moore, that brought attention to the common problem many Black Americans face: lack of adequate health care treatment. Dr. Susan Moore, like many other Black Americans in the United States faced medical bias while she was admitted to an Indiana hospital. Dr. Moore was discharged, despite pleas for more comprehensive care, and was readmitted to the hospital where she passed shortly after. Unfortunately, she was among many Indiana resident readmitted after not receiving adequate health care.
In 2018, 80 percent of Indiana hospitals were financially penalized for excess readmission rates, totaling approximately $12 million, an increase of $3 million from three years ago. Increased readmission rates are a large contributor to excess healthcare spending in the United States. This is also an indicator of the quality of care patients are receiving while admitted into hospitals. The excessive and frequent hospital readmissions motivated Medicare’s 2012 program attempting to reduce readmissions with financial penalties. Following the implantation of the Hospital Readmission Reduction Program, racial gaps in healthcare quality in readmission rates can be best identified by analyzing 2019 census estimates of population demographics and the Centers for Medicare and Medicaid Services’ (CMS) readmission ratios or targeted conditions in Indiana counties. Indiana hospitals continue to be fined for excessive amounts of readmissions, however very little research has been conducted on the demographics of the population these hospitals serve.
Figure 1. Readmission Ratio for Heart Attack Patients Using Percent Non-White Population Comparing 2013 to 2018
My thesis addresses the deficiency of Indiana hospitals to provide equal and quality care to admitted patients with pneumonia, heart failure and acute myocardial infarction. I hypothesized that counties with higher percent nonwhite population will have higher readmission ratios. But when you compared overtime the hospital readmission reduction program will have decreased the disparities in readmission ratios. In Figure 1, we see the trend line in 2013 has a slight increase, overall indicating that readmission ratios increased as percent non-white population increased. This reveals that while the correlation is weak, there is a slight positive correlation. After multiple years of the program being implemented we see that in 2018 the trend line is negatively sloping indicating readmission ratios decrease as percent non-white population increases. While this is only one of the three conditions that were included in my thesis similar findings were displayed in Pneumonia and Heart Failure cases.
Overall, the study concludes, with some limitations, that the Hospital Readmission Reduction Program has been effective in reducing the racial disparities in hospital readmissions. However, my study also presented that on average Indiana hospitals have had an increase in readmissions since 2013. These findings indicate an overall decrease in quality and performance from Indiana hospitals since 2013. While this is not what I expected to see since the Hospital Readmission Reduction Program was supposed to lower readmissions, it does align with the 2018 statistics that I stated previously. As I said there are several limitation that further research should seek to address. And it is important that hospital readmission continue to be researched and that this could enact policy change to better Indiana hospital’s performance.
Sydnie A. Hill is a Senior at Indiana University studying Healthcare Managements and Policy with a minor in Public Health, preparing to graduate in May 2021. She would like to express her extreme gratitude to her advisor Professor Kosali Simon for her invaluable advice, continuous support, and patience during the research, writing and presentation of her honors thesis.
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