• Proposed changes to the Hospital Readmissions Reduction Program (HRRP) are out

    I told you changes were coming. The details are in the proposed rule (PDF), just out. When I can, I will read the whole thing carefully, though I hope somebody beats me to it (paging Jordan Rao). I’m also happy to crowd source (paging Ashish Jha, Karen Joynt, Brad Flansbaum, and anyone else who cares.)

    Meanwhile, I’ll just flag this bit from the pages marked 479-480:

    In accordance with section 1886(q)(5)(A) of the Act, effective for the calculation of the readmissions payment adjustment factors in FY 2015, we are proposing to expand the applicable conditions and procedures to include: (1) patients admitted for an acute exacerbation of COPD; and (2) patients admitted for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). At this point, it is not feasible for CMS to add readmission measures for three of the conditions identified by MedPAC in its 2007 Report to Congress (CABG, PCI, and other vascular conditions). We note that inpatient admissions for PCI and other vascular conditions seem to be decreasing, and these 480 procedures are being performed more in hospital outpatient departments. This shift in setting for these procedures may make their future inclusion in the Hospital Readmssion Reduction Program more difficult and impracticable. We are also exploring how we may address CABG in this program at a future time.

    Also, on the page marked 820:

    [W]e are proposing to incorporate the Planned Readmission Algorithm into the AMI, HF, PN, and Total Hip/Knee Replacement readmission measures in addition to the Hospital-Wide Readmission Measure beginning in 2013.

    I didn’t read yet about what the “planned readmission algorithm” is, though I can guess the gist. My point here is that we now know more about what CMS is planning: COPD, THA, TKA are explicitly planned to join, AMI, HF, and PN under the HRRP program. A hospital-wide (all-condition) measure appears to still be on the table.

    Comments to the proposed rule due by 5 p.m. EST on July 25, 2013.

    UPDATE: More here.


    • A tangential question…does anyone know if the penalties apply to Medicare Advantage programs or traditional Medicare patients only?

    • Thanks for the post, Austin. I am brand new to the blogging-world. This is actually my first reply :).

      I think this is such an interesting topic, but there is a lot of confusion that surrounds it. CMS defines a readmission as, “an admission to a subsection(d) hospital within 30 days of a discharge from the same or another subsection(d) hospital.” From my research that’s all it really says.

      So, if a patient is discharged from the hospital with a CHF related condition, and is then readmitted 10 days later for a broken arm, does that mean the hospital will get dinged? Or does the readmission have to be related to CHF? It would be great to get some clarity on this. Thanks.

      Once again, great post. Looking forward to following you guys!