Definition
The Hospital Readmissions Reduction Program (HRRP) is the Medicare program, created by the Affordable Care Act, that reduces inpatient payments to hospitals with higher-than-expected 30-day readmission rates for selected conditions and procedures.
HRRP payment reductions began with discharges on or after October 1, 2012 (fiscal year 2013). CMS measures risk-adjusted 30-day readmissions for six conditions and procedures: acute myocardial infarction, heart failure, pneumonia, chronic obstructive pulmonary disease, coronary artery bypass graft surgery, and elective primary total hip or knee arthroplasty. The reduction is capped at 3% of a hospital's base operating DRG payments and applies to acute care hospitals paid under the inpatient prospective payment system; critical access hospitals are excluded.
Since fiscal year 2019, as required by the 21st Century Cures Act, CMS compares each hospital with peers that serve similar proportions of patients dually eligible for Medicare and Medicaid. Because the reduction applies to base payments for all of a hospital's Medicare discharges, a penalty triggered by a handful of conditions affects revenue broadly.
Post-discharge contact is one of the main operational levers on readmissions. AHRQ puts the average 30-day all-cause adult readmission at $16,300, and structured programs such as the Care Transitions Intervention and Project RED lowered readmissions with follow-up as a core component. See post-discharge follow-up and Transitional Care Management.
How Consig handles it
Post-discharge follow-up is one of Consig's core use cases: the automation dials, verifies identity, walks the structured protocol, and documents the call, and red-flag answers go to a person live within seconds or into the care team's queue. See post-discharge follow-up.