Medicare Payment and Reimbursement
Hospital Readmissions Reduction Program Overview
October 18, 2012
10:32 am
The Affordable Care Act (ACA) establishes the Hospital Readmissions Reduction Program, effective for discharges from an applicable hospital beginning on or after Oct. 1, 2012. This program requires that payments to those hospitals under section 1886(d) of the Social Security Act (The Act) be reduced to account for certain excess readmissions. This fact sheet discusses various aspects of the Hospital Readmissions Reduction Program.
To promote quality of care, the Centers for Medicare & Medicaid Services (CMS) developed hospital quality-of-care measures that compare patient outcomes across different hospitals. These measures include hospital risk-standardized readmission measures for:
- Acute myocardial infarction (AMI) 30-day Risk Standardized Readmission Measure (NQF #0505)
- Heart failure (HF) 30-Day Risk Standardized Readmission Measure (NQF #0330)
- Pneumonia (PN) 30-day Risk Standardized Readmission Measure (NQF #0506)
The measures, originally developed for public reporting as a part of the Hospital Inpatient Quality Reporting (IQR) Program, are endorsed by the National Quality Forum (NQF), and have been publicly reported on the Hospital Compare website since 2009 to encourage quality improvement and lower readmission rates.
