hospitalBig city hospitals in the United States have been severely penalized for readmission of patients with heart attacks, heart failure and pneumonia, according to research presented at the American Heart Association’s Scientific Sessions 2014.

In 2013, 2,200 hospitals forfeited more than $280 million in Medicare funds due to readmission penalties stipulated by the Affordable Care Act, researchers said.

“Major urban hospitals serving poorer, under-employed and under-educated patients are affected the most by the penalties for readmission,” said Arshad Javed, M.D., chief author of the study.

Researchers used census figures and other indicators to evaluate the socioeconomic status of the patient population in the large hospitals.

Detroit and Newark have the nation’s highest average readmission penalties. Chicago is one of eight Northern cities with significantly higher readmission penalties compared to hospitals in the rest of the state, researchers said.

Cuts in Medicare payments for safety net hospitals could lead to more reduced access to care, Javed said.

Readmission penalties should be adjusted for the socioeconomic status of the patient population, researchers said. Hospital-to-home initiatives may improve patient care and outcomes more than a penalty system.