• The future of Medicare’s Hospital Readmissions Reduction Program (HRRP)

    Do you know where the HRRP is heading and when? If so, how did you find the details? I ask because I’ve had a hard time tracking them down and in writing. With the help of some sources,* I finally have. So you don’t have to, I’ve documented it all below.

    First, the program currently penalizes hospitals for high readmission rates for three conditions: acute myocardial infarction, heart failure, and pneumonia. This we all know, right?

    But what does the future hold? Turn to Section 3025 of the Payment Protection and Affordable Care Act (PPACA). It includes,

    Beginning with fiscal year 2015, the Secretary shall, to the extent practicable, expand the applicable conditions beyond the 3 conditions for which measures have been endorsed [] to the additional 4 conditions that have been identified by the Medicare Payment Advisory Commission in its report to Congress in June 2007 and to other conditions and procedures as determined appropriate by the Secretary.

    A clue! A clue! So, let’s turn to that 2007 MedPAC report, shall we? What conditions does it “identify”? They’re listed in Table 5-3.

    MedPAC readmissions

    Among them, chronic obstructive pulmonary disease (COPD), coronary artery bypass graft (CABG), percutaneous transluminal coronary angioplasty (PTCA), and other vascular conditions would be new. And, there are four of them, just like the PPACA said. It also said the Secretary may add others deemed appropriate. The scuttlebutt seems to be that an all-condition measure will be among them.

    But there’s more! QualityNet reports,**

    For 2013 public reporting, CMS has 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). These measures were first introduced during the September 2012 dry run.

    HWR is the all-condition measure. I had not heard about THA and TKA measures being on the table. But, if QualityNet is right, these three will be publicly reported soon.

    Should we expect public reporting to precede payment penalties? If so, then the COPD, CABG, PTCA, and other vascular conditions measures ought to be reported in 2014. And, in 2015, all of these are to be used for penalties.

    * I haven’t asked if folks who helped me find this stuff want attribution so I’m withholding it by default.

    ** I can’t tell from its site what QualityNet is or how it gets its information. It was passed to me from a source I trust, and that’s all I can say for now. UPDATE: See “About QualityNet.”


    • Dear Austin,

      As far as we can see from the Home Care side of the healthcare industry, there are changes being made in most hospitals. One such change is what they are terming, Transitional Care Management. These are managers who were either case managers, RNs, or Social Workers whose responsibilities are to manage an inpatient from the day of admission to discharge with follow-ups for 30 days thereafter. They are finding (although there is no study) that readmissions are more likely to occur to the 30% of the patients who live home alone. And, most of the readmissions could have been prevented. The majority of readmissions are due to malnutrition, dehydration, and medication imbalances. Then of course the above lists leaves the patient lightheaded or unsteady on their feet which causes a fall.

      So, our advice to community hospitals is to team-up with a home care company who provides caregivers for their patients. Caregivers are trained to observe, provide nutritious meals within dietary restrictions, and remind the patient to take their medications as prescribed by the physician.

      Much more needs to be done if community hospitals expect to survive. A 2% penalty on a reimbursement is a huge cut for community hospitals.