As required under the Affordable Care Act (ACA), CMS began imposing a penalty on hospitals with excessive Medicare readmissions in FY2013 (October 1, 2012) as part of the Hospital Readmissions Reduction Program (HRRP).
CMS defines a "readmission" as someone who has been readmitted to the same or another acute care facility within 30 days of an initial hospital stay. For the first two years, the HRRP applied to Medicare patients with diagnoses of acute myocardial infarction (AMI), heart failure, or pneumonia, but the program was expanded in FY2015 to include elective hip or knee replacement and congestive obstructive pulmonary disease (COPD) patients. CMS will expand the program again in FY2017 with the addition of coronary artery bypass graft (CABG) patients.
The program excludes patients who are transferred to another acute care facility within 30 days and patients who have planned readmissions for things such as chemotherapy or rehabilitation. The HRRP applies to all IPPS facilities but excludes psychiatric, rehabilitation, long term care, children's cancer, and critical access hospitals, as well as hospitals located in Maryland.
In the nearly three years the program has been in place, hospitals and regulators alike have learned a great deal about readmissions and the key factors driving them. We have even witnessed some unintended consequences from the HRRP. This paper discusses ten things that are important to know about readmissions.
