The Hospital Readmissions Reduction Program
The Hospital Readmissions Reduction Program, or HRRP, is a CMS value-based payment program that reduces payments to hospitals with excess readmissions for specific conditions. The program was established under the Affordable Care Act to incentivize hospitals to improve care coordination and reduce avoidable returns to the hospital within thirty days of discharge.
HRRP Measures
HRRP currently tracks readmission measures for conditions including acute myocardial infarction, heart failure, pneumonia, chronic obstructive pulmonary disease, total hip and knee arthroplasty, and coronary artery bypass graft surgery. Each measure calculates an excess readmission ratio comparing a hospital's predicted readmission rate to an expected rate based on national performance and patient case mix.
Risk Factors for Readmission
Common risk factors contributing to readmissions include inadequate discharge planning, medication reconciliation errors, insufficient patient education, lack of timely follow-up appointments, and social determinants of health such as transportation barriers and housing instability. Identifying high-risk patients before discharge allows targeted interventions to reduce their likelihood of returning.
Care Transitions
Effective care transition programs include structured discharge planning beginning early in the hospital stay, comprehensive medication reconciliation, teach-back education methods to confirm patient understanding, and scheduled follow-up appointments before discharge. Transitional care models often include post-discharge phone calls or home visits to catch problems before they escalate to readmission.
Community Partnerships
Hospitals increasingly partner with community organizations, home health agencies, and skilled nursing facilities to support patients after discharge, particularly those with limited social support or complex chronic conditions. These partnerships help address social determinants of health that traditional clinical interventions alone cannot resolve.
Payment Penalties
Hospitals with higher than expected readmission rates receive a payment penalty applied to all Medicare fee-for-service base operating DRG payments for the following fiscal year, up to a maximum reduction. Because these penalties compound annually and affect the entire Medicare payment base, readmission reduction has become a top priority across clinical, quality, and case management departments working together.