Readmissions Payment Adjustment Factors

$179 / year

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This dataset states the factors that are to be used for Readmissions Payment Adjustments based on the FY 2017 and FY 2018 applicable period of July 1, 2012, to June 30, 2015, and would be used for proposed payments for FY 2017 and FY 2018 discharges, as discussed in the FY 2018 IPPS/LTCHPPS proposed rule.

Complexity

Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program, which requires CMS (Centers for Medicare & Medicaid Services) to reduce payments to IPPS (Inpatient Prospective Payment System) hospitals with excess readmissions, effective for discharges beginning on October 1, 2012. The regulations that implement these provisions are in subpart I of 42 CFR part 412 of the same Section 3025 of the Affordable Care Act.

In the FY 2012 IPPS (Inpatient Prospective Payment System) final rule, CMS finalized the following policies with regard to the readmission measures under the Hospital Readmissions Reduction Program:

– Defined readmission as an admission to a subsection (d) hospital within 30 days of a discharge from the same or another subsection (d) hospital; Adopted readmission measures for the applicable conditions of acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN);

– Established a methodology to calculate the excess readmission ratio for each applicable condition, which is used, in part, to calculate the readmission payment adjustment. A hospital’s excess readmission ratio is a measure of a hospital’s readmission performance compared to the national average for the hospital’s set of patients with that applicable condition.

– Established a policy of using the risk adjustment methodology endorsed by the National Quality Forum (NQF) for the readmissions measures to calculate the excess readmission ratios, which includes the adjustment for factors that are clinically relevant including certain patient demographic characteristics, comorbidities, and patient frailty.

– Established an applicable period of three years of discharge data and the use of a minimum of 25 cases to calculate a hospital’s excess readmission ratio for each applicable condition.

The Maryland hospitals and hospitals located in Puerto Rico are not subject to the Hospital Readmissions Reduction Program, so are excluded from this data.

Date Created

2017

Last Modified

2019-10-30

Version

2019-10-30

Update Frequency

Irregular

Temporal Coverage

2017-2019

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare & Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Readmissions Reduction Program, Readmissions Payment Adjustment Factors, Readmissions Reduction Program Medicare Advantage, Prospective Payment System, Readmissions Reduction Program, Readmissions Payment Adjustments

Other Titles

Readmission Reduction Program Summary, Reduction Program Conditions, Readmissions Reduction Program Factors for Medicare Advantage, Readmission Reduction Program Summary, Reduction Program Conditions, Readmissions Adjustment Factors, Payment Adjustment Factors

NameDescriptionTypeConstraints
YearThe year for which the data is recorded.daterequired : 1
CMS_Certification_NumberCMS Certification Numberintegerlevel : Nominal required : 1
Readmissions_Adjustment_FactorsReadmissions Adjustment Factors Related to Paymentnumberlevel : Ratio required : 1
YearCMS Certification NumberReadmissions Adjustment Factors
2017100010.9935
2017100050.9911
2017100060.9942
2017100070.999
2017100080.9981
2017100110.9931
2017100120.9852
2017100160.9944
2017100181.0
2017100190.9894