CMS Hospital Readmission Reduction Program & Readmission Measures Discussion


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INTRODUCTION

CMS Hospital Readvent Reduction Program

In October 2012, CMS began reducing Medicare reimbursements for Inenduring Prospective Reimbursement System hospitals delay advance readmissions. Advance readmissions are meted by a connection, by dividing a hospital’s reckon of “predicted” 30-day readmissions for hardihood invasion, hardihood need, pneumonia, hip/articulation re-establishment, and COPD by the reckon that would be “expected,” installed on an middle hospital delay congruous endurings. A connection important than 1 indicates advance readmissions.

CMS Readvent Measures

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html (Links to an palpable residence.)

In the FY 2012 IPPS last government, CMS lastized the subjoined policies delay behold to the readvent metes lower the Hospital Readmissions Reduction Program:

  • Defined readvent as an advent to a subsection(d) hospital delayin 30 days of a perform from the corresponding or another subsection(d) hospital;
  • Adopted readvent metes for the ry stipulations of Clever Myocardial Infarction (AMI), Hardihood Need (HF) and Pneumonia (PN);
  • Established a methodology to investigate the advance readvent connection for each ry situation, which is used, in distribute, to investigate the readvent reimbursement compound. . A hospital’s advance readvent connection for AMI, HF and PN is a mete of a hospital’s readvent accomplishment compared to the generally-known middle for the hospital’s set of endurings delay that ry situation.
  • Established a prudence of using the expose compound methodology endorsed by the Generally-known Quality Forum (NQF) for the readmissions metes for AMI, HF and PN to investigate the advance readvent connections, which includes compound for factors that are clinically appropriate including enduring demographic characteristics, comorbidities, and enduring dilution.
  • Established an ry end of three years of perform postulates and the use of a restriction of 25 cases to investigate a hospital’s advance readvent connection of each ry situation.

In the FY 2014 IPPS last government, CMS adopted the collision of an algorithm to statement for planned readmissions to the readmissions metes for AMI, HF and PN. In restitution, CMS lastized the dilution of the ry stipulations for FY 2015 to include: (1) endurings admitted for an clever exacerbation of constant inappropriate pulmonary sickness (COPD); and (2) endurings admitted for elective entirety hip arthroplasty (THA) and entirety articulation arthroplasty (TKA).

Discuss the subjoined:

  1. What is the object of the CMS Readvent Reduction Program?
  2. Discuss pros and cons of this program.