Case Management

Mentor moment: Readmissions reduction program beginning to take shape

Case Management Weekly, May 4, 2011

CMS has begun to lay the foundation for the coming hospital readmission reduction program as part of the inpatient prospective payment system (IPPS) proposed rule posted April 19.

The program, which was mandated by The Patient Protection and Affordable Care Act (PPACA), will reduce Medicare payments to hospitals that have high readmission rates.

Within the IPPS proposed rule, CMS adopted the National Quality Forum (NQF) definition of readmission: occurring when a patient is discharged from the applicable hospital to a non-acute setting (for example, home health, skilled nursing, rehabilitation or home) and then is admitted to the same or another acute care hospital within a specified time period from the time of discharge from the index hospitalization.

CMS specified the readmission time frame is 30 days; however, there are exclusions for readmissions unrelated to the original diagnosis, as specified by the HQF, Kimberly Anderwood Hoy, director of Medicare and compliance at HCPro, said in a recent blog.

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