What is the Hospital Readmissions Reduction Program?

HRRP is a value-based Medicare purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, prevent avoidable readmissions.

According to the Centers for Medicare & Medicaid Services, “Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare.”

What’s not mentioned on the CMS page is that health care providers can be penalized for delivering less-than-optimal care and bad patient experiences. Moreover, one of the most commonly-used criteria that Medicare, Medicaid and Private Payers use, in determining the level of payments hospitals and physicians receive for their services, is the rate of Patient Readmissions. That’s where outpatient pharmacies can have a tremendously positive impact — not only on readmissions, but also on the quality of patient care and hospital revenues.

The single most common cause of preventable hospital readmissions

According to studies, as much as 70% of all preventable hospital readmissions are caused by outpatients failing to comply with their discharge prescription protocols. Making matters worse for hospitals, according to our proprietary software’s analytics, hospital readmissions from prescription non-compliance are, on average, much more expensive than other readmissions.

How can your outpatient pharmacy help your hospital reduce readmissions?

The simple answer is, of course, to help ensure that your outpatients take their discharge medications as directed. While there are a number of easy-to-use apps designed to improve medication adherence, there is a significant problem with patient acceptance of tracking apps.

According to a 2021 study by the Journal Of Managed Care + Specialty Pharmacy, “More than 50% of smartphone users refused to use an app because they feared their personal information would be compromised.” Practically speaking, the rate of refusal among smartphone users means that any pharmacy using medication-tracking software would be required to manage the majority of its patient follow-up with person-to-person contact. Which is exactly why ProxsysRx’s Readmission Reduction Program is based on calling and communicating directly with patients.

Our program involves multiple steps — including 1) assistance in making any necessary appointments, 2) thoroughly discussing prescription protocols, to ensure patients and their caregivers understand their own responsibilities, and 3) ensuring there are no potential interactions with patients’ existing medications. What’s more, our program calls for ten “touches” during the first 30 days post-discharge.

How effective are outpatient calling programs?

Some studies have shown that discharged patients receiving follow-up phone calls are 23% less likely to be readmitted within 30 days of discharge. In our experience, results can be much higher. One of ProxsysRx’s most successful programs was implemented in a Mississippi-based health system. In our first 12 months of service, our outpatient pharmacy filled over 18,000 discharge prescriptions — then managed patient follow-up. During that time, the hospital’s medication-related readmissions decreased 79%.

How Can ProxsysRx Help Your Hospital Minimize Readmissions?

There are so many ways to implement effective patient follow-up programs. For more information, contact Howard Hall. C: 214.808.2700 | howard.hall@proxsysrx.com


Additional CMS Information on the Hospital Readmissions Reduction Program

HRRP improves Americans’ health care by linking payment to the quality of hospital care. CMS incentivizes hospitals to improve communication and care coordination efforts to better engage patients and caregivers on post-discharge planning.

We’ve included measures of conditions and procedures that make a big difference in the lives of large numbers of people with Medicare. HRRP, along with the Hospital Value Based Purchasing (Hospital VBP) and Hospital-Acquired Condition (HAC) Reduction Programs, is a major part of how we add quality measurement, transparency, and improvement to value-based payment in the inpatient care setting.

Research shows that hospital readmission rates differ across the nation. This gives us an opportunity to improve the quality of care and save taxpayer dollars by incentivizing providers to reduce excess readmissions.

What measures are included in the Hospital Readmissions Reduction Program?

We use the excess readmission ratio (ERR) to assess hospital performance. The ERR measures a hospital’s relative performance and is a ratio of the predicted-to-expected readmissions rates. We calculate an ERR for each condition or procedure included in the program:

  • Acute Myocardial Infarction (AMI)
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Heart Failure (HF)
  • Pneumonia
  • Coronary Artery Bypass Graft (CABG) Surgery
  • Elective Primary Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA)

HRRP doesn’t include the Hospital-Wide All-Cause Readmission (HWR) measure, which is included in the Hospital Inpatient Quality Reporting (IQR) Program.

What counts as a readmission under the Hospital Readmissions Reduction Program?

The HRRP 30-day risk standardized unplanned readmission measures include:

Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission.

Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason.

Readmissions to any applicable acute care hospital are counted, no matter what the principal diagnosis was. The measures exclude some planned readmissions.

How does the Hospital Readmissions Reduction Program adjust payments?

For each eligible hospital, we calculate the payment adjustment factor. The payment adjustment factor corresponds to the percent a hospital’s payment is reduced. The payment adjustment factor is a weighted average of a hospital’s performance across the six HRRP measures during the HRRP performance period. We apply the payment adjustment factor for all discharges in the applicable fiscal year, no matter the condition.

You can find more information in the QualityNet Methodology section.

What is the Review and Correction period?

The 30-day Review and Correction period allows applicable hospitals to review and correct their HRRP Payment Reduction and component result calculations as reflected in their HSR (i.e., Payment Adjustment Factor, Dual Proportion, Peer Group Assignment, Neutrality Modifier, ERR, and Peer Group Median ERRs) prior to them being used to adjust payments. Hospitals can’t submit corrections to the underlying claims data or add new claims to the data extract during this period.

Each program year, we let hospitals know the exact dates of the Review and Correction period on the QualityNet website.

How will I know whether CMS incorporated changes to the Hospital Readmissions Reduction Program?

Changes to the program requirements happen through rulemaking. These changes are published annually after a public comment period, with the Inpatient Prospective Payment System /Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS) Final Rule.

How Can ProxsysRx Help Your Hospital Minimize Readmissions?

There are so many ways to implement effective patient follow-up programs. For more information, contact Howard Hall. C: 214.808.2700 | howard.hall@proxsysrx.com