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The Health Reform Law Section-By-Section
Hospital Readmissions Reduction Program
Section 3025 of the Affordable Care Act
Read the statutory language applicable to this section
Brief analysis
Federal regulations
Federal agency guidance
Starting in fiscal year 2012, inpatient prospective payments to a hospital will be reduced based on the dollar value of the hospital's percentage of preventable Medicare readmissions for three high volume procedures as chosen by the Secretary of HHS with the assistance of the National Quality Forum.
Definition of Readmission
The statute states that a readmission will occur when a patient is discharged from a IPPS
hospital and then re-admitted to the
same or another IPPS hospital within a time period
specified by the Secretary of HHS from the date of the first discharge.
Quality Improvement Program
The statute also mandates that the Secretary of HHS "make available" a Quality Improvement Program through the use of patient safety organizations
for hospitals with a high severity adjusted readmission rate that have not taken appropriate steps to reduce such readmissions.
Reporting and Public Posting
Hospitals will be required to submit patient data to the Secretary of HHS for the calculation of readmission rates and the Secretary is required to post patient readmission rates per hospital on the HHS website.
Federal Regulations
Final Rule: Hospital Readmission Reduction Program
On August 31, 2012, CMS published final rules in the Federal Register entitled Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals’ Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for
Ambulatory Surgical Centers. These final rules include implementation of provisions of the Hospital Readmission Reduction Program including the methodology to calculate the
adjustment factor, the portion of the hospital’s payment that is reduced by the adjustment factor, and the process under which the hospitals have the opportunity to review and
submit corrections for their readmissions information prior to the information being
posted on the Hospital Compare website. The link is an excerpt from the final rule with the text on Section 3025.
Effective Date: October 1, 2012.
Final Rule: Hospital Readmission Reduction Program
On August 18, 2011, CMS published final rules in the Federal Register entitled Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY 2012 Rates; Hospitals’ FTE Resident Caps for Graduate Medical Education Payment. These final rules include a number of provisions to implement various sections of the Affordable Care Act. Among these provisions are the requirements for a hospital readmissions reduction program and related quality data reporting measures. The link is an excerpt from the final rule with the text on Section 3025.
Effective Date: October 1, 2011
Federal Agency Guidance
Redesigning the Medicare Inpatient PPS to Reduce
Payments to Hospitals with High Readmission Rates
Article posted on the CMS website from the Summer 2009 Health Care Financing Review. Although written before passage of the health reform law, the fact that this is posted on the CMS website suggests that CMS will rely on this, at least in part, for designing the readmission reduction program.