For FY 2014, the maximum possible penalty under the Hospital Readmissions Reduction Program increases to 2 percent of a hospital’s base operating DRG payments. In the Final Rule, CMS establishes additional exclusions for additional planned readmissions for each of the three existing readmissions measures—pneumonia; acute myocardial infarction; and heart failure. CMS also adds two new readmissions measures for FY 2015—chronic obstructive pulmonary disease (NQF #1891); and total hip arthroplasty/total knee arthroplasty (NQF # 1551).
Readmission ratios for FY 2014 are based on MedPAR claims with discharge dates during the July 1, 2009 to June 30, 2012 period. Of the 3,359 hospitals subject to the readmissions reduction program for FY 2014, 2,225 hospitals will receive some readmissions penalty. 171 of these hospitals will receive a readmissions penalty greater than 1 percent, and 18 will receive the maximum penalty of 2 percent. The final readmissions adjustment factors for FY 2014 are available from the CMS website by clicking here.