Jose F. Figueroa, MD, MPH
2017 DICP Faculty Fellowship Recipient
Jose F. Figueroa, MD, MPH, Instructor, Harvard Medical School, Department of Medicine, Brigham and Women’s Hospital
Mentor: Ashish K. Jha, MD, MPH, K.T. Li Professor of Medicine, Harvard Medical School; Professor, Department of Health Policy and Management, Director, Harvard Global Health Institute, Harvard T.H. Chan School of Public Health
Division Chief: David W. Bates, MD, MSc, Professor of Medicine, Harvard Medical School; Chief, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital; Professor of Health Policy and Management, Harvard T.H. Chan School of Public Health
“Do Hospital Penalties Improve Health Equity? Impact of the Hospital Readmissions Reduction Program on Minority Populations and the Hospitals that Serve Them”
The Affordable Care Act (ACA) has made reducing readmissions a national priority by introducing the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with higher-than-expected readmission rates. Early data suggest that readmission rates for incentivized conditions (acute myocardial infarction, heart failure, and pneumonia) have declined for Medicare patients nationally from over 21 percent in 2009 to under 18 percent in 2015.1 While these are average effects across the nation, the effect of HRRP on racial and ethnic minorities is unknown. Prior work has shown that blacks and Hispanics are at substantially higher risk of being readmitted. Beyond patients, we know that minority-serving hospitals have higher readmission rates for their patients, even after accounting for differences in patient characteristics. Given the ongoing national shift towards value-based care,2 it is critical to understand whether and how HRRP has impacted care for minority populations and the hospitals that care for them. Failure to do this work will substantially increase the likelihood that we fail to learn the lessons for how best to improve care for minority populations. Therefore, in this study, using a natural quasi-experimental design and mixed-methods approach, we seek to: (1) understand the impact of the HRRP policy on changes in readmission rates for racial/ethnic minorities and whether it has led to meaningful reductions in health disparities, (2) determine the effect of HRRP on minority-serving hospitals, and (3) identify effective strategies for reducing readmission rates for racial and ethnic minorities using a national survey of over 1,000 U.S. hospitals.
Jose F. Figueroa, MD, MPH is an Instructor of Medicine at Harvard Medical School and an Associate Physician at Brigham & Women’s Hospital. He graduated from Harvard Medical School and the Harvard School of Public Health in 2011 with a concentration in health policy. He recently completed his residency in Internal Medicine at the Brigham & Women’s Hospital, where he now serves as Faculty Director of the BWH Residency Management & Leadership Track. Currently, his main research interests include: 1) identifying needs and successful models of care for high cost populations; 2) improving quality of care for vulnerable patients, including racial/ethnic minorities, frail elderly, and people with mental health disease; and 3) understanding the impact of federal and state policies on health care quality and costs.