An Opportunity to Improve Medicare's Planned Readmissions Measure

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.

Comparison of 30-day planned and unplanned readmissions to huge hospital in China

“…Most studies suggested that a 7-day cut-off is an effective intervention point for early readmission and preventable ones [16]. The readmissions within the rst seven days following hospital discharge were more likely to be preventable than those occurring within a late period of 8-30 days [16][17][18]. Some studies have shown that early readmissions (≦7 days) within 30 days of discharge are twice as likely to be preventable compared to late readmissions, with adjusted preventability rates decreasing signi cantly after day 7 post-discharge.…”

Variation in resource utilization associated with the surgical management of ovarian cancer

“…We followed the CMS approach in calculating the average risked adjusted hospital cost 26 . We considered four measures of patient outcome: unplanned admission within 90 days of discharge as defined by an algorithm developed by CMS 20,30 ], prolonged LOS, re-operation, and postoperative complications. To test the association between hospital cost and patient outcome, we regressed patient outcome on patient characteristics and risk-adjusted hospital cost.…”

“…We identified unplanned readmissions to acute care hospitals within 90 days of discharge from the hospital following primary surgery. To define unplanned readmission we followed an algorithm developed by CMS 19,20 .…”

Evaluation of the Sex-and-Age-Specific Effects of PM2.5 on Hospital Readmission in the Presence of the Competing Risk of Mortality in the Medicare Population of Utah 1999–2009

“…Patients were required to be alive at the time of discharge and discharged to home/self-care, home care with an organized home health service organization, home under care of a home IV drug therapy provider, or home hospice. Patients with a planned readmission were treated as not readmitted [28]. Duration was measured as days from discharge to 30 days post-discharge.…”