Policy Examples

• Section 3025 of the Affordable Care Act requires the Health and Human Services (HHS) Secretary to establish the Hospital Readmission Reduction Program (HRRP) and reduce payments to Inpatient Prospective Payment System (IPPS) hospitals for excess readmissions beginning October 1, 2012. source & source

• The original HRRP penalties as the formula does not address socioeconomic factors. Patients can have more trouble recuperating because they can’t afford their medications or lack social support to follow physician instructions. At the onset of the program, the Centers for Medicare and Medicaid Services (CMS) stated that hospitals should not be held to different standards. In 2018, CMS eased the penalties against safety net hospitals to address these concerns. source

Outcome Evidence

• In 2015, CMS revised the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies must meet in order to participate in the Medicare and Medicaid programs. source
• IIn 2019, CMS published a revision to the 2015 discharge planning rule, arming patients with further information needed to make decisions about their care transitions and improving quality by requiring hospitals to provide patients access to information. source
• As of 2018, hospital readmissions had declined under HRRP. 80% of hospitals evaluated under HRRP had associated penalties for Medicare inpatient stays. This represents a reduction in reimbursements for hospitals of $564 million, up from the $528 million in 2017. source