The Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP) penalizes hospitals having excess inpatient rehospitalizations within 30 days of index inpatient stays for targeted conditions. Observation hospitalizations are increasing in frequency and may clinically resemble inpatient hospitalizations, yet HRRP excludes observation in index and 30-day rehospitalization counts. Using 100% 2014 Medicare fee-for-service claims and CMS’s 30-day rehospitalization methodology, we modeled how observation hospitalizations impact HRRP metrics when counted as index (denominator) and 30-day (numerator) rehospitalizations. Of 3,806,772 index hospitalizations for HRRP conditions, 418,923 (11%) were observation; 18% (155,553/876,033) of rehospitalizations were invisible to HRRP due to observation hospitalization as index (34%; 63,740/188,430), 30-day outcome (53%; 100,343/188,430), or both (13%; 24,347/188,430). By ignoring observation hospitalizations as index and 30-day events, nearly one of five HRRP rehospitalizations is missed. Policymakers might consider this an opportunity to address broad challenges of the two-tiered observation and inpatient hospital billing distinction.

Medicare 和 Medicaid 服务中心 (CMS) 的医院再入院减少计划 (HRRP) 对因目标情况而在指数住院后 30 天内再次住院过多的医院进行处罚。观察性住院治疗的频率正在增加，临床上可能类似于住院治疗，但 HRRP 不包括指数观察和 30 天再住院计数。使用 100% 2014 年医疗保险按服务收费索赔和 CMS 的 30 天再住院方法，我们模拟了观察住院在计算为指数（分母）和 30 天（分子）再住院时如何影响 HRRP 指标。在 3,806,772 例因 HRRP 情况而住院的指标中，418,923 例 (11%) 为观察；18% (155,553/876, 033) 由于观察住院作为指标​​ (34%; 63,740/188,430)、30 天结果 (53%; 100,343/188,430) 或两者 (13%; 24,347/188,430)，HRRP 看不到再住院。通过忽略作为指标和 30 天事件的观察住院，将近 5 例 HRRP 再住院中有 1 例被遗漏。政策制定者可能会认为这是一个解决两级观察和住院医院计费区别的广泛挑战的机会。