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Hospital-wide All-Cause Unplanned Readmission (HWR) Measure

The HWR measure includes Medicare Fee-for-Service (FFS) beneficiaries aged 65 years or older who were discharged from the hospital during the 2010 calendar year. Similar to the publicly reported readmission measures for acute myocardial infarction, heart failure, and pneumonia, this measure is based on administrative claims data.

For each hospital, the HWR measure estimates a risk-standardized readmission rate (RSRR) based on unplanned readmissions to any acute care hospital, 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 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. The measure also adjusts for service mix (discharge diagnosis category), accounting for differences in the types of conditions and procedures cared for by hospitals.

The measure has been endorsed by the National Quality Forum.

Hospitals Included in the Measure

The HWR measure is calculated for all non-federal short-stay acute care hospitals and critical access hospitals. Prospective payment system (PPS)-exempt cancer hospitals and PPS-exempt psychiatric facilities and units are excluded from the measure.

Measure Development

The HWR measure was developed by a team of clinical and statistical experts from Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE). YNHHSC/CORE developed the measure through a transparent process that included input a public comment period.

The measure methodology is described in the Hospital-Wide Readmission Technical Report (PDF-2.3 MB).


For a complete list of dry run resources—including measure fact sheets, frequently asked questions (FAQs), dry run timeline, and information about the national provider calls—see Resources.

Questions and Comments

The Centers for Medicare & Medicaid Services (CMS) will receive and respond to hospital and stakeholder questions and comments via e-mail during the September 2012 dry run. Questions about the HWR measure should be sent to: Do NOT submit patient-identifiable information (e.g., Date of Birth, Social Security Number, Health Insurance Claim Number) to this address.

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