Which program reduces payments to hospitals that have high readmission rates for pneumonia, congestive heart failure, or acute myocardial infarction?

Which program reduces payments to hospitals that have high readmission rates for pneumonia, congestive heart failure, or acute myocardial infarction?

• A. ACOs
• B. MCOs
• C. Bundled Payments
• D. Hospital Readmission Reduction Program

Answer: (D)

Reducing payments to hospitals with higher readmission rates is what the Hospital Readmission Reduction Program does. This program, created under the Affordable Care Act, is run by CMS and ties a portion of Medicare payments to how well hospitals keep patients from being readmitted within 30 days after certain conditions, including pneumonia, congestive heart failure, and acute myocardial infarction. If a hospital’s risk-adjusted readmission rate is higher than expected, Medicare trims a share of its payments as a penalty. The aim is to push hospitals to improve discharge planning, post-discharge care coordination, and transitions to home or other care settings to prevent avoidable returns. Other models like ACOs focus on sharing savings from coordinating care across providers, MCOs manage care plans in Medicaid or Medicare Advantage, and bundled payments cover all services for an episode of care. They aren’t specifically about penalizing hospitals for high readmission rates, which is why the readmission reduction program is the best fit for this scenario.

Reducing payments to hospitals with higher readmission rates is what the Hospital Readmission Reduction Program does. This program, created under the Affordable Care Act, is run by CMS and ties a portion of Medicare payments to how well hospitals keep patients from being readmitted within 30 days after certain conditions, including pneumonia, congestive heart failure, and acute myocardial infarction. If a hospital’s risk-adjusted readmission rate is higher than expected, Medicare trims a share of its payments as a penalty. The aim is to push hospitals to improve discharge planning, post-discharge care coordination, and transitions to home or other care settings to prevent avoidable returns.

Other models like ACOs focus on sharing savings from coordinating care across providers, MCOs manage care plans in Medicaid or Medicare Advantage, and bundled payments cover all services for an episode of care. They aren’t specifically about penalizing hospitals for high readmission rates, which is why the readmission reduction program is the best fit for this scenario.