Hospital Excess Readmissions Reduction Program

$199 / year

This dataset is about Medicare payments reductions for Inpatient Prospective Payment System hospitals with excess readmissions, which started in In October 2012. Excess readmissions are measured by a ratio, by dividing a hospital’s number of “predicted” 30-day readmissions for heart attack, heart failure, and pneumonia by the number that would be “expected,” based on an average hospital with similar patients. A ratio greater than 1 indicates excess readmissions.

Complexity

Section 3025 of the 2010 Patient Protection and Affordable Care Act established the Hospital Readmissions Reduction Program (HRRP) as an addition to section 1886(q) of the 1965 Social Security Act. This was partly a result of the 2007 “Promoting Greater Efficiency in Medicare” report which recognized the prevalence and cost of readmissions nationwide. This program established a method for calculating a health system’s expected readmission rate and created a system for financially penalizing hospital systems that exceeded their expected readmission rate. The HRRP officially began in 2013 and applied to all acute care hospitals except the following: psychiatric, rehabilitation, pediatric, cancer, and critical access hospitals. Maryland hospitals were excluded, due to the state’s unique all-payer model for reimbursement. In the first two years, only readmissions for heart attack, heart failure, and pneumonia were counted; in 2015, chronic obstructive pulmonary disease (COPD) and elective hip replacement and knee replacement were added. CMS plans to add coronary artery bypass graft (CABG) surgery to the list in 2017.
A hospital’s readmission rate is calculated and then risk adjusted. A ratio of predicted or measured readmissions compared to expected readmissions (based on similar hospitals) is calculated, called the excess readmission ratio. This is calculated for each of the applicable conditions. This ratio is then used to calculate the estimated payments made by CMS to the hospital for excess readmissions as a ratio of the payments by CMS for all discharges. This creates a readmissions adjustment factor, which is then used to calculate a financial penalty to the hospital for excess readmissions. To reach these calculations, up to three previous years of a hospital’s data and a minimum of 25 cases for each applicable condition are used.

Date Created

2012-07-26

Last Modified

2018-01-26

Version

2018-01-26

Update Frequency

Annual

Temporal Coverage

2011-2016

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare & Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Hospital Compare, Online Surveys, Access Healthcare, Quality-of-Care, Quality Assurance, Hospital Survey, Hospital Experience, Healthcare Associated Infections, CAUTI, CLABSI

Other Titles

Catheter-Associated Urinary Tract Infections, Central Line-Associated Bloodstream Infections

Name Description Type Constraints
Provider_IDCMS certification number (CCN). Identification number of the hospital within the CMS dataset.integerrequired : 1 level : Nominal
Hospital_NameName of the hospital (also referred to as the provider)stringrequired : 1
NPIThe NPI is a 10-digit unique identification number for covered health care providers. This is an enriched column.integerlevel : Nominal
State_FIPS_CodeThe FIPS state code is a two-digit Federal Information Processing Standards (FIPS) code which uniquely identifies state and certain other associated areas.stringrequired : 1
StateCommonwealth of the Northern Marianas Islandsstring-
State_AbbreviationCommonwealth of the Northern Marianas Islands: MPstringrequired : 1
Measure_NameThe measure name of the Hospital Readmission Reduction Program.stringrequired : 1
Measure_DescriptionThe description of the measure in HRRP (Hospital Readmission Reduction Program)stringrequired : 1
Number_of_DischargesNumber of patients discharged from the hospital during that period.integerlevel : Ratio
FootnoteFootnote describes an additional piece of information given separately for the compiled data.integerlevel : Ratio
Excess_Readmission_RatioExcess Readmission Ratio is the ratio of Predicted Readmission Rate to the Expected Readmission Rate based on similar hospitals.numberlevel : Ratio
Predicted_Readmission_RateIndicates the patients predicted readmission rate.numberlevel : Ratio
Expected_Readmission_RateIndicates the patients expected readmission rate.numberlevel : Ratio
Number_of_ReadmissionsIndicates the number of patients readmitted in a hospital within a particular time period.stringlevel : Ratio
Start_DateThe first day the data measures were collected. The date format is YYYY-MM-DD.daterequired : 1
End_DateThe last day the data measures were collected. The date format is YYYY-MM-DD.daterequired : 1
ICD10_CodeThe International Classification of Diseases ICD-10 code/codes for the specific measure.stringrequired : 1
ICD10_DescriptionDescription used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care.stringrequired : 1
HCPCS_CodeThe Healthcare Common Procedure Coding System (HCPCS) code/codes for the specific measure.stringrequired : 1
HCPCS_DescriptionDescription of the Level II of the HCPCS standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.stringrequired : 1
LatitudeThe latitude corresponding to the Hospital's address.-
LongitudeThe longitude corresponding to the Hospital's address.-
Provider_IDHospital_NameNPIState_FIPS_CodeStateState_AbbreviationMeasure_NameMeasure_DescriptionNumber_of_DischargesFootnoteExcess_Readmission_RatioPredicted_Readmission_RateExpected_Readmission_RateNumber_of_ReadmissionsStart_DateEnd_DateICD10_CodeICD10_DescriptionHCPCS_CodeHCPCS_DescriptionLatitudeLongitude
360245GLENBEIGH39OhioOHREADM-30-HF-HRRPHeart failure (HF) 30-Day Readmission Rate52011-07-012014-06-30I50.9Heart failure, unspecifiedG9680This code is for onsite acute care treatment of a nursing facility resident with CHF; may only be billed once per day per beneficiary
360365AVITA ONTARIO39OhioOHREADM-30-HF-HRRPHeart failure (HF) 30-Day Readmission Rate52013-07-012016-06-30I50.9Heart failure, unspecifiedG9680This code is for onsite acute care treatment of a nursing facility resident with CHF; may only be billed once per day per beneficiary
360245GLENBEIGH39OhioOHREADM-30-PN-HRRPPneumonia (PN) 30-Day Readmission Rate52011-07-012014-06-30J18.9Pneumonia, unspecified organismG9679This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary
360365AVITA ONTARIO39OhioOHREADM-30-PN-HRRPPneumonia (PN) 30-Day Readmission Rate52013-07-012016-06-30J18.9Pneumonia, unspecified organismG9679This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary
360245GLENBEIGH39OhioOHREADM-30-HIP-KNEE-HRRPRate of readmission after hip/knee replacement52011-07-012014-06-30S78.119DComplete traumatic amputation at level between unspecified hip and kneeL5850Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist
010173ST VINCENT'S CHILTON1AlabamaALREADM-30-HF-HRRPHeart failure (HF) 30-Day Readmission Rate52013-07-012016-06-30I50.9Heart failure, unspecifiedG9680This code is for onsite acute care treatment of a nursing facility resident with CHF; may only be billed once per day per beneficiary
360245GLENBEIGH HEALTH SOURCES39OhioOHREADM-30-HF-HRRPHeart failure (HF) 30-Day Readmission Rate52013-07-012016-06-30I50.9Heart failure, unspecifiedG9680This code is for onsite acute care treatment of a nursing facility resident with CHF; may only be billed once per day per beneficiary
360245GLENBEIGH HEALTH SOURCES39OhioOHREADM-30-HF-HRRPHeart failure (HF) 30-Day Readmission Rate52012-07-012015-06-30I50.9Heart failure, unspecifiedG9680This code is for onsite acute care treatment of a nursing facility resident with CHF; may only be billed once per day per beneficiary
100329OVIEDO MEDICAL CENTER12FloridaFLREADM-30-HF-HRRPHeart failure (HF) 30-Day Readmission Rate52013-07-012016-06-30I50.9Heart failure, unspecifiedG9680This code is for onsite acute care treatment of a nursing facility resident with CHF; may only be billed once per day per beneficiary
360365AVITA ONTARIO39OhioOHREADM-30-HIP-KNEE-HRRPRate of readmission after hip/knee replacement52013-07-012016-06-30S78.119DComplete traumatic amputation at level between unspecified hip and kneeL5850Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist