1. HISPANIC-SERVING HOSPITALS REPORT MORE BARRIERS TO REDUCING READMISSIONS: RESULTS OF A NATIONAL SURVEY OF U.S. HOSPITAL LEADERS Jennifer Gilbert Massachusetts General Hospital Harvard T.H. Chan School of Public Health

2. What is the Hospital Readmissions Reduction Program?  HRRP: Readmissions Penalty Program  Started in 2012 under ACA  Conditions: AMI, HF, PNA (+ COPD, THA/TKA)  Program Specifics:  Hospitals are penalized for “excess readmissions”  1-3% holdback on base Medicare payments CMS.gov, 2015

3. Why did we focus on MSHs?  Readmission rates higher at Minority-Serving Hospitals (MSHs), including Hispanic-Serving Hospitals (HSHs)  As a result, likely to be penalized  Poor and Minority patients more likely to be readmitted irrespective of site of care  Medicaid patients 50% higher rates  Black patients 15% higher rates  Hispanic patients 15-20% higher than whites Joynt et al., JAMA 2011; Rodriguez et al. AHJ 2011; Joynt et al., Circulation Outcomes 2011.; Joynt et al., JAMA 2013.

4. National Hospital Readmissions Survey  Objective:  To determine why readmission rates are higher at MSHs Unique barriers to reducing readmissions?  National Survey of U.S. Hospital Leaders  Targeted CMOs, CQOs, CNOs, etc.

5. Methods: Survey  Sampled 1600 U.S. Acute Care Hospitals  900 Minority-Serving Hospitals Top 25% Hospitals with highest proportion of blacks of all U.S. acute care hospitals HSH: Top 10% of hospitals with highest proportion of hispanics in study  700 Non-MSHs Excluded critical access hospitals, children’s, and psychiatric hospitals Joynt et al. JQPS. 2014

6. Methods: Analysis  1001 Respondents (62.5% response rate)  223 HSHs (22.3%)  778 non-HSHs (77.7%)  Comparison of HSHs vs. Non-HSHs  Weighted for non-response  Adjusted by Hospital Characteristics  Adjusted by Safety-Net Hospital status Safety-Net Hospitals provide substantial care to low- income, uninsured populations Isolates the independent effect of Hispanic-serving status

7. Who Responded to the Survey?

8. Hospital Characteristics Minority-Serving Hospitals Non-Minority Serving Hospitals Hospital Size Small110 (19.7%)162 (37.5%) Medium295 (52.8%)230 (53.2%) Large154 (27.6%)40 (9.7%) Teaching Status Teaching236 (42.1%)131 (30.3%) Non-teaching323 (57.8%)301 (69.7%) Region Northeast61 (10.9%)75 (17.4%) Midwest94 (16.8%)127 (29.4%) South358 (64.0%)126 (29.2%) West46 (8.2%)104 (24.1%)

9. Controlling for Safety-Net Status Type of Insurance Minority-Serving Hospitals Non-Minority Serving Hospitals Medicare44.1%48.4% Medicaid22.4%18.2%

10. Barriers in Reducing Readmissions Comparing HSHs vs. non-HSHs

11. Results: Hospital and Community- Related Barriers Lack of nursing home/rehab care Lack of visiting nursing services Lack of financial resources Staffing issues *p<0.01 **p<0.0001 % Hospitals Reporting Great Challenge ** *

12. Results: Patient-Related Barriers Mental Health/ Substance Abuse Resources Lack of transportation Language Barriers Homelessness % Hospitals Reporting Great Challenge * *p<0.01 **p<0.0001 **

13. Conclusions  Hispanic-Serving Hospitals report more barriers to reducing readmissions:  More Patient-Related Factors  More Hospital-Related Factors  Slightly More Community-Related Factors

14. Acknowledgements  Harvard School of Public Health  Ashish Jha, MD MPH  Jose Figueroa, MD MPH  Arnold Epstein, MD  Karen Joynt, MD MPH  Funded by the National Institutes of Health (NIH)

15. Thank you!  Questions?