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An Opportunity to Improve Medicare's Planned Readmissions Measure
Chad Ellimoottil1,2,3, Roger K Khouri2,3, Apoorv Dhir2,3
1Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA. cellimoo@med.umich.edu.
Abstract:
In the Hospital Readmission Reduction Program (HRRP), the Centers for Medicare & Medicaid Services (CMS) utilizes a planned/unplanned algorithm to prevent hospitals from being penalized for scheduled rehospitalizations. We evaluated version 3.0 of the CMS planned readmission algorithm and hypothesized that some readmissions categorized as planned by the HRRP algorithm may actually be unplanned. We identified 143,054 index admissions and 16,116 thirty- day readmissions for 131 hospitals. Only 1252 readmissions were considered planned according to Medicare's readmission algorithm. The majority of these planned readmissions (723 [57.8%]) had an "emergent" or "urgent" admission type listed on the readmission claim, and many (513 [41.0%]) had emergency department charges, suggesting unanticipated returns to the hospital. HRRP should consider using the admission type variable and/or the presence of emergency department charges as a source of information when determining whether a readmission is planned or unplanned.
Insights
The Centers for Medicare & Medicaid Services (CMS) planned readmission algorithm may misclassify unplanned hospital readmissions. Data suggests many "planned" readmissions show signs of being emergent, impacting hospital penalties.
Area of Science:
- Health Services Research
- Healthcare Policy
- Medical Economics
Background:
- The Hospital Readmission Reduction Program (HRRP) by the Centers for Medicare & Medicaid Services (CMS) aims to reduce hospital readmissions.
- CMS uses a planned/unplanned algorithm to differentiate between scheduled and unscheduled rehospitalizations for penalty calculations.
Purpose of the Study:
- To evaluate version 3.0 of the CMS planned readmission algorithm.
- To determine if readmissions classified as planned by the algorithm are truly unplanned.
Main Methods:
- Analysis of 143,054 index admissions and 16,116 thirty-day readmissions across 131 hospitals.
- Examination of readmission claims data, including admission type and emergency department charges.
Main Results:
- Only 1252 readmissions were classified as planned by the algorithm.
- A significant majority (57.8%) of these planned readmissions had an "emergent" or "urgent" admission type.
- Many planned readmissions (41.0%) incurred emergency department charges, indicating potential unpredicted hospital returns.
Conclusions:
- The current CMS planned readmission algorithm may inaccurately categorize unplanned readmissions as planned.
- Incorporating admission type and emergency department charges into the algorithm could improve accuracy.
- Refining the algorithm is crucial for fair HRRP penalty assessments.