Hospital Readmissions Reduction Program

Overview

Section 3025 of the 2010 Affordable Care Act (Public Law 111-148) requires the Secretary of the Department of Health and Human Services to establish a Hospital Readmissions Reduction Program whereby the Secretary reduces Inpatient Prospective Payment System (IPPS) payments to hospitals for excess readmissions beginning on or after October 1, 2012 (Fiscal Year [FY] 2013).

To comply with these requirements, the Centers for Medicare & Medicaid Services (CMS) adopted, and publicly reported, the following 30-day risk standardized readmission measures for the Hospital Readmissions Reduction Program.

Effective Program Year Finalized in IPPS Rule 30-day Risk Standardized Readmission Measures
FY 2013 and FY 2014 FY 2012
  • Acute myocardial infarction (AMI)
  • Heart failure (HF)
  • Pneumonia
FY 2015 and FY 2016 FY 2014
  • AMI
  • HF
  • Pneumonia
  • Chronic obstructive pulmonary disease (COPD)
  • Elective primary total hip and/or total knee arthroplasty (THA/TKA)
FY 2017 (Upcoming) FY 2015 (New)
  • AMI
  • HF
  • Pneumonia
  • COPD
  • THA/TKA
  • Coronary Artery Bypass Graft (CABG) Surgery (New)

Fiscal Year 2016 Hospital Readmissions Reduction Program

As shown above, the FY 2016 Hospital Readmissions Reduction Program calculates Excess Readmission Ratios for five measures (AMI, HF, Pneumonia, COPD, THA/TKA) to determine the payment adjustment factors for eligible hospitals.

For information regarding the calculation of the payment adjustment factors, refer to the Readmissions Reduction Program page on the CMS website.

The Review and Corrections Process

For the Hospital Readmissions Reduction Program, hospitals will have 30 days to review and submit corrections on information used to calculate their Excess Readmission Ratios. This 30-day period begins the day hospitals’ receive their Hospital-Specific Reports (HSRs), via their QualityNet Secure Portal account and ends 30 days later. For FY 2016, the 30-day review period is from June 16, 2015 to July 16, 2015.

While CMS is providing hospitals with detailed discharge-level information as part of their HSRs, the Review and Corrections process does not allow hospitals to submit corrections related to the underlying claims data, or to add new claims to the data used to calculate the Excess Readmission Ratios.

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