Readmissions & CMS HRRP Forecasts, Predictions & Analytics

Dexur forecasts readmission rates for all measures under the Hospital Readmission Reduction Program (HRRP) 1-3 years in advance of the final published date. Dexur achieves this by replicating the complex CMS HRRP methodology using the Medicare Claims data and checking the measure-level readmission rate to analyze if Hospitals have a high, medium, or low chance to fall in penalty.

HRRP is intended to improve the communication and coordination between caregivers and patients in developing discharge plans to avoid possible readmissions. The program achieves the goal by linking payments to value outcomes. As of 2023, CMS considers six conditions as part of the program: COPD, Pneumonia, TKA/THA, CABG, Heart Failure and AMI. The payments are determined based on the hospital's performance during a 3-year period.

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See which condition causes readmission at your hospital and its impact. Readmission rates are a hospital quality measure and reflect dimensions of quality of patient care. Studies have shown a relationship between readmissions, length of stay, cost of care, and mortality.For instance, in-hospital mortality has been found to be higher for patients who are readmitted versus those who are not. Lower Readmission Rates have lower Medicare Spending Per Beneficiary (MSPB) which improves a hospital standing in CMS’ Value-Based Purchasing (VBP) program.

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