Unlocking the Mystery: Exploring the Differences in Readmission Penalties for the Dual-Eligible

Dual-eligible readmission penalties differ from other readmission penalties by taking into account the proportion of patients a hospital serves who are dually eligible for Medicare and Medicaid, essentially penalizing hospitals less severely if they have a higher percentage of these complex, often high-needs patients, as dual eligibility is considered a marker of significant social risk factors that can contribute to higher readmission rates; this adjustment helps to mitigate penalties for hospitals serving populations with greater social needs.