A hospital readmission occurs when a patient is admitted to a hospital within a specified time period after being discharged from an earlier (initial) hospitalization. For Medicare, this period is defined as 30 days and includes hospital readmissions to any hospital, not just the hospital at which the patient initially was hospitalized. In 2011 CMS primary focus was to reduce the 30day CHF readmission rates, with the overall goal of improving patient center care while adding educational and motivational techniques to produce positive outcomes and mitigate readmission rates. On October 1, 2014, CMS added Total Joint Replacement and COPD in addition to CHF, AMI, Pneumonia, on October 1, 2013, to be penalized for readmission within 30days; the penalty will range from 1% to a max of 3% in October 2014.
In Medicare’s current climate they use an “all-cause” definition of readmission, meaning that hospital stays within 30 days of discharge from an initial hospitalization will be considered readmissions, regardless of the reason for the readmission. This all-cause definition used in calculating both the national average readmission rate and each hospital’s specific readmission rate. Today the total Medicare penalties assessed on hospitals for readmissions will increase to $528 million in 2017, $108 million more than in 2016.