Overview of the Hospital Readmissions Reduction Program
The Hospital Readmissions Reduction Program, often abbreviated HRRP, reduces Medicare payments to hospitals with higher than expected rates of thirty-day readmissions for specific conditions. RHIA candidates should understand both the clinical conditions tracked and the methodology used to calculate a hospital's excess readmission ratio.
Conditions Included in HRRP
The program tracks readmissions following an initial hospitalization for conditions including acute myocardial infarction, heart failure, pneumonia, chronic obstructive pulmonary disease, elective total hip and total knee arthroplasty, and coronary artery bypass graft surgery. Each condition is measured using a risk-adjusted methodology that accounts for patient case mix differences between hospitals.
Excess Readmission Ratio
The excess readmission ratio compares a hospital's predicted readmission rate, based on its specific patient population and case mix, to the expected readmission rate for a hospital with average performance treating a similar population. A ratio greater than one indicates the hospital experienced more readmissions than expected, which contributes to a payment penalty of up to three percent of total Medicare inpatient payments.
Exclusions from Readmission Counts
- Planned readmissions, such as a staged procedure scheduled in advance, are excluded from the measure
- Readmissions for unrelated conditions may be excluded depending on the specific measure specification
- Transfers to another acute care hospital are generally not counted as a readmission for the transferring facility
Strategies to Reduce Readmissions
Hospitals reduce readmissions through robust discharge planning, medication reconciliation, timely post-discharge follow-up appointments, and enhanced communication with post-acute care providers such as skilled nursing facilities and home health agencies. Accurate documentation of discharge disposition and follow-up plans supports both quality improvement and correct measure calculation.
HIM's Contribution
HIM professionals support HRRP compliance by ensuring accurate coding of principal diagnosis, which determines whether an admission qualifies as an index admission for one of the tracked conditions, and by supporting data abstraction for quality reporting submissions.
Exam Tip
Remember that HRRP is risk-adjusted, meaning hospitals are compared against an expected rate specific to their patient population, not against a single flat national benchmark.