Forum Session

The Medicare Hospital Readmissions Reduction Program: Time for an Update?
June 21, 2013

Managers

Sally Coberly, PhD & William J. Scanlon, PhD, Consultant

Summary

Everyone agrees that reducing avoidable hospital readmissions (admission to a hospital within 30 days of discharge from an earlier hospital stay) is good for patients and good for the Medicare program–and could potentially save $1 billion if such readmissions were reduced by just 10 percent. To encourage hospitals to improve discharge planning and care transitions and therefore reduce readmissions, the Patient Protection and Affordable Care Act of 2010 included the Medicare hospital readmissions reduction program (HRRP). HRRP currently assesses penalties on hospitals with higher-than-expected readmission rates for patients with myocardial infarction, heart failure, and pneumonia. Approximately $280 million in penalties was assessed in fiscal year 2013 for readmissions between 2009 and 2011. Criticisms of the program have focused on its failure to take into account the effects of socioeconomic and other factors on readmissions, the negative correlation between readmissions and mortality for some conditions, and the reliability of the performance measure, among others. Not surprisingly, suggestions for refinements to the program have emerged. This Forum session described the HRRP as implemented, examined the criticisms that have been leveled against it, and looked at potential refinements including those discussed this spring by the Medicare Payment Advisory Commission.

Speakers

Mark Miller, PhD (bio)
Executive Director
Medicare Payment Advisory Commission
   Slides: Part 1 and Part 2

Karen E. Joynt, MD, MPH (bio)
Associate Physician, Cardiovascular Division
Brigham and Women's Hospital and
Veterans Administration Boston Healthcare System
Instructor
Department of Health Policy and Management
Harvard School of Public Health
   Slides

Elna Nagasako, MD, PhD, MPH (bio)
Instructor
Division of General Medical Sciences
Department of Medicine
Washington University School of Medicine in St. Louis
   Slides

Related Materials

Medicare Payment Advisory Commission, Report to the Congress: Medicare and the Health Care Delivery System, June 2013, pages 91-116.

Robert Wood Johnson Foundation, "The Revolving Door: A Report on U.S. Hospital Readmissions, " February 11, 2013.

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