The Hospital Readmissions Reduction Program (HRRP) is a critical initiative by Medicare designed to improve the quality of healthcare for patients. It works by financially incentivizing hospitals to lower their rates of avoidable readmissions. This program pushes healthcare providers to enhance their care coordination and communication, especially concerning discharge planning. By focusing on these areas, hospitals can better support patients and their caregivers, leading to fewer returns to the hospital.
Why the Hospital Readmissions Reduction Program Matters
The HRRP is vital because it directly links Medicare payments to the quality of care hospitals provide. The Centers for Medicare & Medicaid Services (CMS) uses this program to encourage hospitals to actively engage patients and their families in planning after discharge. This proactive approach is intended to reduce unnecessary hospital readmissions and improve patient outcomes. It’s part of a broader strategy that includes other programs like the Hospital Value-Based Purchasing (VBP) and Hospital-Acquired Condition (HAC) Reduction Programs, all aimed at embedding quality and value into inpatient care.
Research has consistently shown significant variations in hospital readmission rates across the country. This variability highlights a substantial opportunity to improve healthcare quality while also being mindful of taxpayer dollars. By rewarding hospitals that effectively reduce readmissions, HRRP aims to drive nationwide improvements in patient care and efficiency.
Who is Affected by the Hospital Readmissions Reduction Program?
The HRRP applies to subsection (d) hospitals, as detailed in the Code of Federal Regulations 42 CFR 412.20. These are primarily acute care hospitals that receive payments under Medicare’s Inpatient Prospective Payment System (IPPS). It is important to note that some hospitals, like those in Maryland, are exempt from HRRP payment reductions due to specific agreements with CMS.
Key Measures in the Hospital Readmissions Reduction Program
To evaluate hospital performance, HRRP uses the excess readmission ratio (ERR). This ratio compares a hospital’s predicted readmission rate to the expected rate, providing a measure of relative performance. EREs are calculated for several conditions and procedures that are significant for Medicare patients:
- Acute Myocardial Infarction (AMI)
- Chronic Obstructive Pulmonary Disease (COPD)
- Heart Failure (HF)
- Pneumonia
- Coronary Artery Bypass Graft (CABG) Surgery
- Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA)
It’s worth noting that while the Hospital-Wide All-Cause Readmission (HWR) measure is important for overall quality reporting in the Hospital Inpatient Quality Reporting (IQR) Program, it is not directly included in the HRRP calculations.
Understanding Readmission in the Context of HRRP
Under HRRP, a readmission is defined as an unplanned admission back into a hospital within 30 days of an initial discharge. This includes readmissions to the same hospital or any other applicable acute care facility, regardless of the principal diagnosis upon readmission. The key factor is that the readmission is unplanned. However, certain planned readmissions are excluded from these measures.
This definition is critical because it emphasizes the program’s focus on preventing avoidable readmissions. Hospitals are encouraged to look beyond just treating the immediate condition and consider the patient’s overall care plan to prevent returns to the hospital setting.
Hospice Care and Reducing Avoidable Readmissions
While HRRP traditionally focuses on reducing readmissions for specific medical conditions, a broader approach to patient care can significantly impact these rates. One such approach involves considering admission for hospice care for patients with serious illnesses. Hospice provides comprehensive comfort care for patients with terminal illnesses, focusing on quality of life rather than curative treatment.
For patients with a principal diagnosis indicating a terminal condition, inpatient or home-based hospice care can be a more appropriate and beneficial care setting than repeated hospitalizations. By transitioning eligible patients to hospice, hospitals can ensure they receive the most suitable care, which aligns with patient needs and preferences while potentially reducing unnecessary hospital readmissions.
Considering admission for hospice care is particularly relevant when the principal diagnosis suggests that the patient’s condition is progressive and unlikely to improve with further acute hospital treatment. In these situations, continued hospital readmissions may not enhance the patient’s quality of life and can be emotionally and financially taxing for families. Hospice care offers a holistic approach, addressing physical, emotional, and spiritual needs, often in a more comfortable and cost-effective setting.
Payment Adjustments and HRRP
For hospitals subject to HRRP, payment adjustments are calculated based on their performance against the readmission measures. A payment adjustment factor is determined for each hospital, reflecting the percentage by which their Medicare payments will be reduced. This factor is a weighted average of the hospital’s performance across all the readmission measures during a specific performance period. Critically, this payment adjustment is applied to all discharges within the applicable fiscal year, irrespective of the patient’s condition.
Further details on the payment adjustment methodology are available on the QualityNet Methodology page, and an informative infographic can be found on the QualityNet Resources page.
Review and Correction Period
Hospitals have a 30-day Review and Correction period to examine their HRRP payment reduction calculations. During this time, hospitals can review their Hospital Specific Report (HSR), which includes the Payment Adjustment Factor, ERR, and other key components. This allows hospitals to identify and correct any discrepancies in the calculations before they are used to adjust payments. However, it’s important to note that hospitals cannot modify the underlying claims data or submit new claims during this period. CMS announces the specific dates for each program year’s Review and Correction period through the Hospital Inpatient Value-Based Purchasing (HVBP) Listserv and on the QualityNet website.
Staying Updated on HRRP Changes
Changes to the Hospital Readmissions Reduction Program are regularly communicated through the HVBP QualityNet listserv. To stay informed about program updates, hospitals and healthcare professionals can subscribe to email updates on the QualityNet website by selecting the “HVBP Notify” List under “Quality Reporting” on the Sign Up for Email Updates page.
Further Resources on HRRP
For more comprehensive information about the Hospital Readmissions Reduction Program, please visit the CMS Hospital Readmissions Reduction Program page or the QualityNet Hospital Readmissions Reduction Program page. These resources provide detailed program specifications, updates, and materials to help hospitals effectively participate in and improve their performance under the HRRP.
By understanding the nuances of HRRP and considering comprehensive patient care strategies, including appropriate admission for hospice care based on principal diagnosis, hospitals can work towards reducing readmissions, improving patient outcomes, and contributing to a more efficient and patient-centered healthcare system.
