Overview

Readmission Measures

The publicly reported 30-day risk-standardized unplanned readmission measures include:

Readmission Measures
Condition-Specific -Acute Myocardial Infarction (AMI)
-Chronic Obstructive Pulmonary Disease (COPD)
-Heart Failure (HF)
-Pneumonia
-Stroke
Procedure-Specific -Coronary Artery Bypass Graft (CABG), New in 2015
-Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA)
Hospital-Wide -Hospital-Wide All-Cause Readmission (HWR)

The Centers for Medicare & Medicaid Services’ (CMS) 30-day risk standardized readmission measures assess a broad set of healthcare activities that affect patients’ well-being. Patients who receive high-quality care during their hospitalizations and their transition to the outpatient setting will likely have better outcomes, such as survival, functional ability, and quality of life.

Most recently, CMS introduced the CABG readmission measure to hospitals and stakeholders in a national dry run in September 2014, and will begin publicly reporting its results as part of the Hospital Inpatient Quality Reporting (IQR) Program in July 2015.

The public reporting of 30-day risk-standardized readmission measures is consistent with the priorities of the Department of Health and Human Services’ National Quality Strategy, which aims to: a) improve health care quality; b) improve the health of the U.S. population; and c) reduce the costs of health care. Public reporting of the CMS 30-day readmission measures fulfills federal mandates in the Deficit Reduction Act (DRA) of 2005 requiring the Secretary of Health and Human Services to make outcome and efficiency measures publicly available under the Hospital IQR Program.

The AMI, COPD, HF, pneumonia, and THA/TKA 30-day risk-standardized measures are also included in the Hospital Readmission Reduction Program under Section 3025 of the Affordable Care Act. This is a pay-for-performance program that reduces payments to hospitals with excess readmissions.

Questions and Comments

CMS contracted with Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE) to develop, reevaluate, and support the implementation of these measures. Please submit questions about the readmission measures to: cmsreadmissionmeasures@yale.edu. For proper handling of inquiries, specify the measure(s) and program(s) to which your questions relate. Do NOT submit patient-identifiable information (e.g., Date of Birth, Social Security Number, Health Insurance Claim Number) to this address.

For any additional questions about the Hospital IQR Program, contact the QualityNet Help Desk at qnetsupport@hcqis.org.

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