How Have 30-Day Readmission Penalties Affected Racial Disparities in Readmissions?: an Analysis from 2007 to 2014 in Five US States

  • Cameron M. KaplanEmail author
  • Michael P. Thompson
  • Teresa M. Waters
Original Research



Thirty-day readmission penalties implemented with the Hospital Readmission Reduction Program (HRRP) place a larger burden on safety-net hospitals which treat a disproportionate share of racial minorities, leading to concerns that already large racial disparities in readmissions could widen.


To examine whether there were changes in Black-White disparities in 30-day readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia following the passage and implementation of HRRP, and to compare disparities across safety-net and non-safety-net hospitals.


Repeated cross-sectional analysis, stratified by safety-net status.


1,745,686 Medicare patients over 65 discharged alive from hospitals in 5 US states: NY, FL, NE, WA, and AR.

Main Measures

Odds ratios comparing 30-day readmission rates following an index admission for AMI, CHF, or pneumonia for Black and White patients between 2007 and 2014.

Key Results

Prior to the passage of HRRP in 2010, Black and White readmission rates and disparities in readmissions were decreasing. These reductions were largest at safety-net hospitals. In 2007, Blacks had 13% higher odds of readmission if treated in safety-net hospitals, compared with 5% higher odds in 2010 (P < 0.05). These trends continued following the passage of HRRP.


Prior to HRRP, there were large reductions in Black-White disparities in readmissions at safety-net hospitals. Although HRRP tends to assess higher penalties for safety-net hospitals, improvements in readmissions have not reversed following the implementation of HRRP. In contrast, disparities continue to persist at non-safety-net hospitals which face much lower penalties.


health policy disparities Medicare hospital medicine 



This study was funded by the Agency for Healthcare Research and Quality (R01 HS023783).

Compliance with Ethical Standards

Conflict of Interest

Dr. Kaplan previously served as a co-investigator on a research contract funded by AbbVie Pharmaceuticals. Dr. Waters has provided expert testimony for several health care providers. All remaining authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_4841_MOESM1_ESM.docx (29 kb)
ESM 1 (DOCX 29 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Cameron M. Kaplan
    • 1
    Email author
  • Michael P. Thompson
    • 2
  • Teresa M. Waters
    • 3
  1. 1.Gehr Family Center for Health Systems ScienceUniversity of Southern California Keck School of MedicineLos AngelesUSA
  2. 2.Department of Cardiac SurgeryUniversity of Michigan Medical SchoolAnn ArborUSA
  3. 3.Department of Health Management and PolicyUniversity of KentuckyLexingtonUSA

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