The hospital readmission reduction program was created as a part of the Affordable Care Act as a way to improve quality of care and reduce overall Medicare costs. Readmissions are defined as a patient being readmitted to any hospital and for any reason within 30 days of discharge from the hospital being analyzed.
Full Answer
What is a hospital readmission for Medicare?
According to Medicare, a hospital readmission is "an admission to an acute care hospital within 30 days of discharge from the same or another acute care hospital." However, a readmittance for follow-up care does not constitute a "readmission" for Medicare.
Are 30-day readmission rates improving?
Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act There appears to be a systematic improvement in readmission rates for patient groups beyond the population of fee-for-service, older, Medicare beneficiaries included in the HRRP.
What is the 30 day risk standardized unplanned readmission measure?
The HRRP 30-day risk standardized unplanned readmission measures include: Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason.
Do hospitals get penalized for readmission reduction?
And every year, most U.S. hospitals get penalized. This year is no exception – 83% of all hospitals face penalties. The hospital readmission reduction program was created as a part of the Affordable Care Act as a way to improve quality of care and reduce overall Medicare costs.
How does the Hospital Readmissions Reduction Program adjust payments?
How long does it take for an unplanned readmission to happen?
What are applicable Hospital Readmissions Reduction Program hospitals?
What measures are included in the Hospital Readmissions Reduction Program?
How will I know whether CMS incorporated changes to the Hospital Readmissions Reduction Program?
What is the Review and Correction period?
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What is the Medicare 30-day readmission rule?
Medicare counts as a readmission any of those patients who ended up back in any hospital within 30 days of discharge, except for planned returns like a second phase of surgery. A hospital will be penalized if its readmission rate is higher than expected given the national trends in any one of those categories.
What counts as a 30-day readmission?
The HRRP 30-day risk standardized unplanned readmission measures include: Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason.
What does readmission within 30 days with the same diagnosis mean?
Readmissions during the 30-day period that follow a planned readmission are not counted in the outcome. In the case of multiple readmissions during the 30-day period, the measure counts only one outcome. Readmissions to the same hospital on the same day for the same principal diagnosis are not counted in the outcome.
How does Medicare define a readmission?
Medicare uses an “all-cause” definition of readmission, meaning that hospital stays within 30 days of a discharge from an initial hospitalization are considered readmissions, regardless of the reason for the readmission.
Does Medicare pay for readmission within 30 days?
Medicare counts the readmission of patients who returned to a hospital within 30 days even if that hospital is not the one that originally treated them. In those cases, the penalty is applied to the first hospital.
Does Medicare penalize hospitals for readmissions?
For the readmission penalties, Medicare cuts as much as 3 percent for each patient, although the average is generally much lower. The patient safety penalties cost hospitals 1 percent of Medicare payments over the federal fiscal year, which runs from October through September.
How is the 30-day readmission rate calculated?
The Observed Readmission Rate is the percentage of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days. It is equal to the Count of 30-Day Readmissions (Column 2) divided by the Count of Index Hospital Stays (Column 1).
What is considered readmission?
A hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval. Readmission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems.
What effect does unnecessary hospital admissions and readmissions have on Medicare?
Historically, nearly 20% of all Medicare discharges had a readmission within 30 days. The Medicare Payment Advisory Commission (MedPAC) has estimated that 12% of readmissions are potentially avoidable. Preventing even 10% of these readmissions could save Medicare $1 billion.
How many readmissions occur within 90 days of discharge from hospitals?
Condition-specific 30- and 90-day readmission rates by post-acute discharge setting are presented in Table 1. For patients with stroke, 30-day readmission rates ranged from 8.8% in HHAs (ischemic) to 14.4% in SNFs (hemorrhagic) and 90-day rates ranged from 18.2% in HHAs (ischemic) to 26.1% in SNFs (hemorrhagic).
How does readmission affect reimbursement?
Medicare Readmission Penalties For hospitals with ERRs greater than one, the higher the ERR, the greater the rate of penalty. CMS caps penalties at 3% of a hospital's reimbursement for its Medicare patient admissions. According to Kaiser, in FY 2017, the average hospital adjustment (among all hospitals) was -0.58%.
What is the cost of readmission?
Data are provided in Supplemental Table 1. In 2018, there were a total of 3.8 million adult hospital readmissions within 30 days, with an average readmission rate of 14 percent and an average readmission cost of $15,200.
AHA Fact Sheet: Hospital Readmissions Reduction Program
The Issue The Affordable Care Act (ACA) required the Centers for Medicare & Medicaid Services (CMS) to penalize hospitals for “excess” readmissions when compared to “expected” levels of readmissions. Since the start of the program on Oct. 1, 2012, hospitals have experienced nearly $1.9 billion of penalties, including $528 million in fiscal year (FY) 2017.
Hospital Readmissions Reduction Program (HRRP) | CMS
The Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions. The program supports the national goal of improving health care for Americans by linking payment to the quality of ...
Hospital Readmissions Reduction Program (HRRP) Archives | CMS
Archived Supplemental Data Files refer to the Archived Supplemental Data Files page on CMS.gov for the supplemental data released with the Inpatient Prospective Payment System (IPPS) final rule each fiscal year (FY).. Archived Finalized Policies. In the FY 2021 IPPS final rule, the Centers for Medicare & Medicaid Services (CMS) finalized the following policies:
Medicare readmissions reduction program penalizes hospitals ...
The May 2022 edition of HFMA’s Cost Effectiveness of Health Report includes a conversation with Lance Robertson, former U.S. Assistant Secretary for Aging at the U.S. Department of Health and Human Services Administration for Community Living, on practical ways the United States can begin to meaningfully address social determinants of health.
Hospital Readmissions Reduction Program Overview - hfma
• Those aspects of the program that relate to the conditions and readmissions to which the program will apply • For the first program year beginning Oct. 1, 2012, the readmission measures and related
Reducing Hospital Readmission: Current Strategies and Future Directions
Prevalence of Hospital Readmission. Though readmission rates in the United States have been high for many years, Jencks and colleagues brought this issue to the forefront with their landmark 2009 article.() Analyzing 2003–2004 claims data, they demonstrated that 19.6% of Medicare beneficiaries were readmitted to the hospital within 30 days of discharge, and 34.0% were readmitted within 90 days.
How long does it take for Medicare to deny readmissions?
Conversely, most managed Medicare payers deny all readmissions within 30 days of discharge. Hospitals have been working to reduce readmissions for approximately six years. The main causes of readmissions are medication noncompliance and lack of timely physician follow-up.
What is the rate of readmission after 7 days?
However, even the best hospital performers have readmission rates of approximately 15 percent.
What is CMS readmission policy?
Managed Medicare companies cite the Centers for Medicare & Medicaid Services (CMS) readmission policy as the basis for their denials .
How long did it take for a patient to recover from a hospital discharge?
Ten days after hospital discharge, he to the emergency department in respiratory and was intubated and ventilated. It took two weeks in critical care for the patient to recover. The two-week admission, including his critical care days, denied due to the payer’s readmission policy. Is that fair?
What to do if you have a readmission from Medicare?
If you're a Medicare patient who suspects that you've received inadequate care associated with a hospital readmission, then consider talking to an attorney. A health care attorney can provide answers for you and can give you guidance on necessary steps to take.
What are the conditions covered by Medicare readmission?
The readmission rates initially only applied to Medicare patients suffering from heart failure, heart attacks, and pneumonia, but the program was expanded to encompass other conditions such as knee and hip replacements and coronary artery bypass graft surgery.
What is a Hospital Readmission?
A hospital readmission is an event that occurs when a patient who had been previously discharged is readmitted within a designated period. This is a bad situation for most patients, as it suggests inadequate care.
Why are hospital readmissions problematic?
Rehospitalizations are problematic for Medicare because they reflect a failure in care and subsequent hospital readmissions result in greater costs. This article discusses the relationship between hospital readmissions ...
How long does it take for a hospital to readmit?
According to Medicare, a hospital readmission is "an admission to an acute care hospital within 30 days of discharge from the same or another acute care hospital." However, a readmittance for follow-up care does not constitute a "readmission" for Medicare.
What is the premature discharge to a setting (usually their home) where the patients' needs aren't met?
Additionally, the premature discharge to a setting (usually their home) where the patients' needs aren't met for post-hospital care makes it highly likely that the patients will be readmitted.
Can patients carry the burden of working to avoid hospital readmissions?
Obviously, patients can't carry the full burden of working to avoid hospital readmissions. Providers and care managers must work on better practices that give the patients more information, resources, and proper instructions on how to take care of themselves. However, patients must have agency in ensuring that their health care needs are satisfied. Here are some ways to achieve this:
What is the unintended consequence of the Medicare readmissions reduction program?
In a previous post, I commented on the unintended consequence of the Medicare hospital readmissions reduction program, specifically that the program is associated with an increase in outpatient mortality. Since hospitals are paid by the DRG (in other words, by the diagnosis), hospitals are financially incentivized to discharge patients as quickly as possible in order to reduce their expenses. The Medicare hospital readmission reduction program was designed to offset that financial incentive by penalizing hospitals that discharge patients prematurely. Overall, the current readmission penalty program appears to be more fair to hospitals that care for socioeconomically disadvantaged patients. However, the danger remains that by creating a barrier for hospitals to readmit patients who truly need to be readmitted, outpatient mortality can increase.
What is the Medicare readmission penalty for 2020?
The 2020 Medicare Readmission Penalty Program. Each year, Medicare analyzes the readmission rate for every hospital in the United States and then imposes financial penalties on those hospitals determined to have excessively high readmission rates. And every year, most U.S. hospitals get penalized. This year is no exception – 83% ...
What is the Medicare quintile?
Medicare divided all U.S. hospitals into quintiles based on the percentage of dual eligible patients. Hospitals were only compared to other hospitals within the same quintile for the purposes of penalty calculation; therefore, a hospital with a high percentage of dual eligible patients was held to a different readmission rate expectation ...
What is readmission reduction?
The hospital readmission reduction program was created as a part of the Affordable Care Act as a way to improve quality of care and reduce overall Medicare costs. Readmissions are defined as a patient being readmitted to any hospital and for any reason within 30 days of discharge from the hospital being analyzed.
Why are hospitals financially incentivized to discharge patients?
Since hospitals are paid by the DRG (in other words, by the diagnosis), hospitals are financially incentivized to discharge patients as quickly as possible in order to reduce their expenses. The Medicare hospital readmission reduction program was designed to offset that financial incentive by penalizing hospitals that discharge patients prematurely.
How does Medicare respond to the penalty based on a given hospital’s patient demographics?
Medicare responded by making 2 adjustments to the penalty based on a given hospital’s patient demographics: The severity of illness of the hospital’s patients (often called the case mix index) with the premise that the sicker a patient is, the more likely that patient is to be readmitted to the hospital. The rate of “dual eligible” patients, that ...
Is the readmission penalty fair?
Overall, the current readmission penalty program appears to be more fair to hospitals that care for socioeconomically disadvantaged patients. However, the danger remains that by creating a barrier for hospitals to readmit patients who truly need to be readmitted, outpatient mortality can increase. November 17, 2019.
How CMS Measures the "30-Day All Cause Rehospitalization Rate" on the Hospital Compare Web Site
Each hospital's 30-day risk-standardized readmission rate (RSRR) is computed in several steps. First, the predicted 30-day readmission for a particular hospital obtained from the hierarchical regression model is divided by the expected readmission for that hospital, which is also obtained from the regression model.
Table of Contents
Each hospital's 30-day risk-standardized readmission rate (RSRR) is computed in several steps. First, the predicted 30-day readmission for a particular hospital obtained from the hierarchical regression model is divided by the expected readmission for that hospital, which is also obtained from the regression model.
How does the Hospital Readmissions Reduction Program adjust payments?
For each eligible hospital, we calculate the payment adjustment factor. The payment adjustment factor corresponds to the percent a hospital’s payment is reduced. The payment adjustment factor is a weighted average of a hospital's performance across the six HRRP measures during the HRRP performance period. We apply the payment adjustment factor for all discharges in the applicable fiscal year, no matter the condition.
How long does it take for an unplanned readmission to happen?
Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason. Readmissions to any applicable acute care hospital are counted, no matter what the principal diagnosis was.
What are applicable Hospital Readmissions Reduction Program hospitals?
Section 1886 (d) (1) (B) of the Social Security Act defines applicable hospitals under HRRP.
What measures are included in the Hospital Readmissions Reduction Program?
We use the excess readmission ratio (ERR) to assess hospital performance. The ERR measures a hospital’s relative performance and is a ratio of the predicted-to-expected readmissions rates. We calculate an ERR for each condition or procedure included in the program:
How will I know whether CMS incorporated changes to the Hospital Readmissions Reduction Program?
These changes are published annually after a public comment period, with the Inpatient Prospective Payment System /Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS) Final Rule.
What is the Review and Correction period?
The 30-day Review and Correction period allows applicable hospitals to review and correct their HRRP Payment Reduction and component result calculations as reflected in their HSR (i.e., Payment Adjustment Factor, Dual Proportion, Peer Group Assignment, Neutrality Modifier, ERR, and Peer Group Median ERRs) prior to them being used to adjust payments. Hospitals can’t submit corrections to the underlying claims data or add new claims to the data extract during this period.