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Publicly reporting risk-standardized, 30-day readmission measures for AMI, COPD, HF, PN, HWR, Stroke, and THA/TKA

The Centers for Medicare & Medicaid Services' (CMS's) 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 better 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. In 2013,CMS 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).

CMS introduced the chronic obstructive pulmonary disease (COPD) and stroke readmission measures to hospitals stakeholders in a national dry run in August 2013.

For information on all the readmission measures, including a list of frequently asked questions (FAQs), refer to Measure Methodology and Resources.

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. 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 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. The HWR measure also adjusts for service mix to account for differences in the types of procedures performed at different hospitals.

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 specify the measure(s) and 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.

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