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Readmission Reduction Incentive Program

Overview

The Maryland Readmissions Reduction Incentive Program (RRIP) incentivizes hospitals to reduce avoidable readmissions by linking rewards and penalties to improvements in readmissions rates. Readmissions occur when a patient is discharged from a hospital and is admitted to any hospital within 30 days of the discharge. Preventable hospitals readmissions may result from complications from previous hospitalization and/or inadequate care coordination, and generate substandard care quality for patients and unnecessary costs. The RRIP compares all-payer readmission rates adjusted for the severity of illness (casemix) for all types of inpatient visits for the calendar year with the rates in the base year (Calendar Year 2013).

Background

Most hospitals in the nation are subject to penalties based on their performance on certain diagnosis-specific Medicare readmissions as part of the federal Medicare Hospital Readmissions Reduction Program (HRRP).The Commission made an initial attempt to encourage reductions in unnecessary readmissions when it created the Admission-Readmission Revenue (ARR) program in 2011. The ARR program limited the amount a hospital could charge per admission episode, providing strong financial incentives to reduce hospital readmissions. The rationale for moving towards an episode-based payment model was to encourage hospitals to reduce readmissions and keep the savings from such reductions. To ensure savings were passed on the public, the Commission also created a complimentary program, The Readmission Shared Savings Policy (RSSP) which reduced the hospital payment rates by a prospective amount.

Current Readmissions Reduction Incentive Program (RRIP)

On January 1, 2014 the State of Maryland entered into a new All-Payer Model demonstration contract with the Center for Medicare and Medicaid Innovation. Among other provisions of this contract, the State is required to reduce the statewide Medicare fee-for-service readmission rate to the national Medicare readmission rate level over the 5-year contract term and make yearly progress towards reducing this gap. In order to meet the new Model requirements, the Commission approved the Readmissions Reduction Incentive Program (RRIP) in April 2014 to further increase the incentives to reduce unnecessary readmissions. The RRIP began to impact hospital revenue starting in Rate Year 2016, with the first performance year of Calendar Year 2014. The initial program focused on providing a set amount of rewards for strong reductions in readmission rates. As the program evolved, penalties were added together with sliding scale payment adjustments that recognized the variation in performance. Lastly, for the Calendar Year 2016 performance year, the Commission changed the methodology to measure hospital performance as the better of attainment (already at a high performing level) or improvement to determine payment adjustments, which strengthens incentives for low-performing hospitals to improve and avoids penalizing high-performing hospitals.

The HSCRC established the following guiding principles for the RRIP through stakeholder input from the performance work group:

  • The measurements used for performance linked with payment must include all patients, regardless of payer.

  • The measurements must be fair to hospitals.

  • Annual targets must be established to reasonably support the overall goal of meeting or outperforming the national Medicare readmission rate by CY 2018.

  • The measurements used should be generally consistent with the CMS readmissions measure.

  • The approach must include the ability to track progress.

Key program components of RRIP methodology:

  • Measure readmissions across hospitals in Maryland using the CRISP (Chesapeake Regional Information System for our Patients) unique patient identification numbers

  • Adjust all-payer readmission rates for patient case-mix and severity of illness

  • Exclude planned admissions from the program using CMS logic with Maryland-specific adjustments (i.e., all deliveries are considered planned)

Key program components of RRIP scoring:

  • Measure hospital performance as the better of attainment (already at a high performing level) or improvement to determine payment adjustments, which strengthens incentives for low-performing hospitals to improve and avoids penalizing high-performing hospitals.

  • Adjust attainment scores to account for readmissions occurring at non-Maryland hospitals.

  • Scale rewards and penalties for attainment based on relative performance to statewide attainment benchmark and for improvement based on relative performance to statewide minimum improvement target.

  • Final revenue adjustments are the better of attainment or improvement.

Rate Year 18

Communications and Memos
Type Title Date
Final Policy
Recommendations
RY18 Readmission Reduction Incentive Program Approved Recommendation 6/08/16
Memos RY18 Readmission Reduction Incentive Program Methodology 7/13/16
Webinars RY18 Quality Program Overview   +   Webinar Slides 7/29/16
Quality Reports and Analyses
Results RY18 Readmission Reduction Incentive Program Results June CY 2016 8/30/16
Calculation Sheet RY18 Readmission Reduction Incentive Program Calculation Sheet 7/13/16

 

Rate Year 17

Communications and Memos
Type Title Date
Final Policy
Recommendations
RY17 Readmission Reduction Incentive Program Approved Recommendation 6/08/16
Memos Readmissions Reduction Incentive Program Policies for Rate Year (RY) 2017

RY17 Quality Program and PAU Shared Savings Combined Scaling Memo
4/2/15

6/22/16
Quality Reports and Analyses
Results RY18 Readmission Reduction Incentive Program Results June CY 2016

RY18 Readmission Reduction Incentive Program Results June CY 2016
7/21/16

7/26/16

 

Prior information below - being formatted as above

July 13, 2016 RY18 Readmission Reduction Incentive Program Methodology
Dec 23, 2015 Readmissions Reduction Program Jan-December 2014
April 2, 2015
March 11, 2015 Readmissions Reduction Incentive Program Policies for Rate Year (RY) 2017
March 11, 2015 Readmissions Reduction Incentive Program Policies for Rate Year (RY) 2017
April 9, 2014 Final Recommendation for Implementing a Hospital Readmission Reduction Incentive Program for FY 2016
June 3, 2014 RY2016 Readmission Incentive Program Webinar Recording
June 3, 2014 Readmission Reduction Incentive Program Webinar Slides
May 9, 2014 Memo on Readmissions Reduction Incentive Program Policies for Rate Year (RY) 2016
April 9, 2014 Final Recommendation for Implementing a Hospital Readmission Reduction Incentive Program for FY 2016
March 13, 2013 CMS Readmission Algorithm Report