Corporate Compliance

Note from the instructor: Financial impacts of the Hospital Readmissions Reduction Program

Medicare Insider, August 14, 2012

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Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the author of this week’s note from the instructor.

Last week, Kimberly posted an overview of the FY 2013 IPPS final rule and the potential impact to a hospital’s operating payments if they do not meet the separate standards for each of the quality based initiatives – up to a 4% reduction. This week I wanted to focus on one of the new programs - the Hospital Readmissions Reduction Program (HRRP) – in a little more detail. In reviewing the final rule, there were numerous comments from the provider community regarding various aspects of how this new program would be implemented but CMS did not seem to budge in its adaptation of the regulation as it was initially proposed. 

CMS did finalize the definition of “readmission” as a readmission occurring when a patient is discharged from an applicable hospital (initial index hospitalization) and then admitted to the same or another acute care hospital within 30 days from the date of discharge from the initial hospital. Only one readmission during the 30 days following the discharge from the initial hospitalization will count as a readmission for purposes of calculating the ratios. None of the subsequent readmissions for that patient within 30 days after discharge would be counted as a new “index” admission. Although providers requested a shorter time period for determining a readmission (i.e. 7 or 14 days), CMS stated that the 30-day time period is consistent with the time period specified for the other related quality measures.

Continue reading Debbie's note at the Medicare Mentor Blog.



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