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Effects of the Hospital Readmissions Reduction Program.

Readmission risk has emerged as a means to infer quality over the past decade.1 Preventable hospital readmissions represent the emergence of medical conditions sufficiently severe in the recovery period that acute care is necessary. Although some short-term health declines resulting in the need for readmission are inevitable, there is evidence that 30-day readmission risk can be reduced through higher quality care.2,3 In recent years, the Centers for Medicare and Medicaid Services created incentives to reduce preventable readmissions for certain key health conditions. The public reporting of readmission rates for 3 common conditions (acute myocardial infarction [AMI], heart failure, and pneumonia) across US hospitals began in 2009,4 and, under the Hospital Readmissions Reduction Program (HRRP) enacted by the US Congress under the Patient Protection and Affordable Care Act, began in 2010 to create a financial incentive to improve care and reduce the risk of readmission by penalizing hospitals for readmission rates above the national average for these conditions.4 According to published literature, there has been a meaningful and significant reduction in readmissions after the introduction of the program.5–7 The program subsequently expanded to include hospitalizations because of chronic obstructive pulmonary disease and for planned knee and hip replacement procedures. Some experts, however, have maintained that the policy has had unintended adverse consequences.8,9 In December 2017, the US Congress, under the 21st Century Cures Act, mandated that MedPAC provide an independent assessment of the impact of the HRRP on the care and outcomes for conditions targeted in the program.10 MedPOLICY STATEMENT TITLE