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Our objective was to determine the impact of adjusting for social risk factors on <jats:styled-content style=\"fixed-case\">HRRP<\/jats:styled-content> penalties.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources\/Study Setting<\/jats:title><jats:p>Claims data for 2\u00a0952\u00a0605 fee\u2010for\u2010service Medicare beneficiaries with acute myocardial infarction (<jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content>), congestive heart failure (<jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content>) or pneumonia from December 2012 to November 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Poverty, disability, housing instability, residence in a disadvantaged neighborhood, and hospital population from a disadvantaged neighborhood were associated with higher readmission rates. Under current program specifications, safety\u2010net hospitals had higher readmission ratios (<jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content>, 1.020 vs 0.986 for the most affluent hospitals; pneumonia, 1.031 vs 0.984; and <jats:styled-content style=\"fixed-case\">CHF<\/jats:styled-content>, 1.037 vs 0.977). Adding social factors to risk adjustment cut these differences in half. Over half the safety\u2010net hospitals saw their penalty decline; 4\u20107.5 percent went from having a penalty to having no penalty. These changes translated into a $17 million reduction in penalties to safety\u2010net hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Accounting for social risk can have a major financial impact on safety\u2010net hospitals. Adjustment for these factors could reduce negative unintended consequences of the <jats:styled-content style=\"fixed-case\">HRRP<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.13133","type":"journal-article","created":{"date-parts":[[2019,3,8]],"date-time":"2019-03-08T13:58:14Z","timestamp":1552053494000},"page":"327-336","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":187,"title":["Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-8653","authenticated-orcid":false,"given":"Karen E.","family":"Joynt Maddox","sequence":"first","affiliation":[{"name":"Cardiovascular Division Department of Medicine Washington University School of Medicine  St. Louis Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mat","family":"Reidhead","sequence":"additional","affiliation":[{"name":"Missouri Hospital Association Hospital Industry Data Institute  Jefferson City Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3033-2001","authenticated-orcid":false,"given":"Jianhui","family":"Hu","sequence":"additional","affiliation":[{"name":"Center for Health Policy and Health Services Research Henry Ford Health System  Detroit Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy J. H.","family":"Kind","sequence":"additional","affiliation":[{"name":"Division of Geriatrics Department of Medicine University of Wisconsin School of Medicine and Public Health, and Department of Veterans Affairs Geriatrics Research Education and Clinical Center  Madison Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1072-6043","authenticated-orcid":false,"given":"Alan M.","family":"Zaslavsky","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0234-1100","authenticated-orcid":false,"given":"Elna M.","family":"Nagasako","sequence":"additional","affiliation":[{"name":"Division of General Medical Sciences Department of Medicine Washington University School of Medicine  St. Louis Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5050-5950","authenticated-orcid":false,"given":"David R.","family":"Nerenz","sequence":"additional","affiliation":[{"name":"Center for Health Policy and Health Services Research Henry Ford Health System  Detroit Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1201598"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2308"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15082"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000326"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2013.0816"},{"key":"e_1_2_8_7_1","unstructured":"JiangHJ WierLM.All\u2010Cause Hospital Readmissions among Non\u2010Elderly Medicaid Patients 2007. 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