Readmission Measures Overview
Publicly reporting risk-standardized, 30-day readmission measures for AMI, HF, PN, HWR, and THA/TKA
The Centers for Medicare & Medicaid Services (CMS) 30-day readmission measures assess a broad set of healthcare activities that affect patients’ well-being. Patients who receive high-quality care during their hospitalizations and their transition to the outpatient setting will likely have improved outcomes, such as survival, functional ability, and quality of life.
The public reporting of 30-day risk-standardized readmission measures is consistent with the priorities of the Department of Health and Human Services’ National Quality Strategy, which aims to: a) improve health care quality; b) improve the health of the U.S. population; and c) reduce the costs of health care.
Public reporting of the CMS 30-day readmission measures fulfills federal mandates in the Deficit Reduction Act (DRA) of 2005 requiring the Secretary of Health and Human Services to make outcome and efficiency measures publicly available under the Hospital Inpatient Quality Reporting Program. In 2009, CMS began to publicly report on Hospital Compare the performance of U.S. hospitals on the 30-day risk-standardized readmission measures for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN) patients.
For 2013 public reporting, CMS has added the Hospital-Wide Readmission (HWR) measure and the readmission measure for patients undergoing elective primary total hip arthroplasty (THA) and/or total knee arthroplasty (TKA). These measures were first introduced during the September 2012 dry run. For information about these readmission measures see Measure Methodology and Resources.
Please note that hospitals will receive their 2013 Hospital-Specific Reports (HSRs) beginning April 18, 2013.
Background
The risk-standardized CMS readmission measures were developed by a team of clinical and statistical experts from Yale and Harvard universities, using a methodology that has been published in peer-reviewed literature. The measures comply with standards for publicly reported outcomes models set forth by the American Heart Association and the American College of Cardiology. These measures have been endorsed by the National Quality Forum. The measures are updated annually using Medicare fee-for-service (FFS) claims to ensure the models are performing well, given trends in the underlying data. The AMI, HF, and PN measure also use Veterans Affairs (VA) administrative data. The CMS readmission measures adjust for each hospital’s case mix (patient age and comorbidities), so that hospitals that care for older, sicker patients are on a “level playing field” with hospitals serving healthier patients.
Hospital-Wide Readmission (HWR)
The HWR measure includes Medicare FFS beneficiaries aged 65 years and older who were discharged from an inpatient stay at a short-term acute care hospital. CMS estimates each hospital’s risk-standardized readmission rate (RSRR) based on unplanned readmissions, for any cause, within 30 days of discharge. Each admission is assigned to one of five specialty cohort groups consisting of related conditions or procedures. The RSRR is calculated using results of the five specialty cohort models. The measure adjusts for case and service mix, accounting for differences in the types of conditions and procedures cared for by hospitals.
THA/TKA Readmission
The THA/TKA risk-standardized readmission measure includes Medicare FFS beneficiaries aged 65 years and older who were electively admitted for primary THA and/or TKA. For each hospital, the readmission measure estimates a risk-standardized readmission rate (RSRR) based on unplanned readmissions to any acute care hospital within 30 days of discharge.
Questions and Comments
CMS has contracted with Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE) to support the implementation of these measures. Questions about the 30-day readmission measures may be sent to Yale at: cmsreadmissionmeasures@yale.edu. To ensure proper handling of inquiries, please reference the specific measure(s) and the specific program(s) to which your questions relate. Do NOT submit patient-identifiable information (e.g., Date of Birth, Social Security Number, Health Insurance Claim Number) to this address.