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L. 111-148","url":"https://www.govinfo.gov/content/pkg/PLAW-111publ148/html/PLAW-111publ148.htm"}},{"date":"2012-10-01","fy":2013,"title":"Penalties begin, capped at 1%","body":"Three conditions count: heart attack, heart failure, and pneumonia.","src":{"label":"FY2013 IPPS final rule","url":"https://www.federalregister.gov/documents/2012/08/31/2012-19079"}},{"date":"2013-10-01","fy":2014,"title":"Cap rises to 2%","body":"The statute steps the maximum reduction up each year until it reaches 3%.","src":{"label":"FY2014 IPPS final rule","url":"https://www.federalregister.gov/documents/2013/08/19/2013-18956"}},{"date":"2014-10-01","fy":2015,"title":"Cap reaches 3%; COPD and hip/knee replacement added","body":"The 3% maximum is set in law and has not changed since.","src":{"label":"FY2014 IPPS final rule, 78 FR 50663–50664 (COPD and hip/knee)","url":"https://www.federalregister.gov/documents/2013/08/19/2013-18956"}},{"date":"2016-10-01","fy":2017,"title":"Bypass surgery added; pneumonia definition widened","body":"The pneumonia group now includes aspiration pneumonia and sepsis with pneumonia present on admission.","src":{"label":"Bypass: FY2015 IPPS final rule, 79 FR 50039. Pneumonia: FY2016 IPPS final rule, 80 FR 49532–49533","url":"https://www.federalregister.gov/documents/2014/08/22/2014-18545"}},{"date":"2016-12-13","fy":null,"title":"Congress orders peer comparisons","body":"The 21st Century Cures Act requires CMS to compare each hospital with hospitals serving similar shares of patients who have both Medicare and full Medicaid.","src":{"label":"21st Century Cures Act, Pub. L. 114-255, sec. 15002","url":"https://www.congress.gov/114/plaws/publ255/PLAW-114publ255.pdf"}},{"date":"2018-10-01","fy":2019,"title":"Peer grouping starts","body":"Hospitals are sorted into five peer groups by dual-eligible share and judged against their group's median. A neutrality modifier keeps total penalties the same as the old method.","src":{"label":"FY2018 IPPS final rule","url":"https://www.federalregister.gov/documents/2017/08/14/2017-16434"}},{"date":"2020-03-27","fy":null,"title":"COVID-19: early-2020 data set aside","body":"A CMS memo dated this day excludes claims from January through June 2020. The gap shows up in the FY2022 through FY2024 calculations.","src":{"label":"FY2021 IPPS final rule, 85 FR 54832","url":"https://www.federalregister.gov/documents/2020/09/18/2020-19637"}},{"date":"2022-10-01","fy":2023,"title":"Pneumonia sits out a year","body":"CMS suppresses the pneumonia measure for FY2023 and removes COVID-19 patients from the other measures.","src":{"label":"FY2022 IPPS final rule","url":"https://www.federalregister.gov/documents/2021/08/13/2021-16519"}},{"date":"2023-10-01","fy":2024,"title":"Pneumonia returns","body":"Patients with a COVID-19 diagnosis stay out of every measure through FY2026.","src":{"label":"FY2023 IPPS final rule; end date: FY2026 IPPS final rule, 90 FR 36930","url":"https://www.federalregister.gov/documents/2022/08/10/2022-16472"}},{"date":"2026-10-01","fy":2027,"title":"Medicare Advantage patients counted; two-year window","body":"Adopted in the FY2026 rule: readmission ratios now include Medicare Advantage patients, the data window shrinks from three years to two, and the COVID-19 exclusion ends. The cut still applies only to traditional Medicare payments.","src":{"label":"FY2026 IPPS final rule, 90 FR 36923–36942","url":"https://www.federalregister.gov/documents/2025/08/04/2025-14681"}},{"date":"2029-10-01","fy":2030,"title":"Next: sepsis","body":"The FY2027 rule adds a seventh measure, readmission after sepsis. Hospitals get confidential reports for FY2028 and FY2029; it counts toward penalties starting FY2030.","src":{"label":"FY2027 IPPS final rule, 91 FR 49901","url":"https://www.federalregister.gov/documents/2026/08/04/2026-15833"}}],"research":[{"theme":"Did readmissions fall?","cite":"Zuckerman et al., NEJM 2016","title":"Readmissions, Observation, and the Hospital Readmissions Reduction Program","url":"https://doi.org/10.1056/NEJMsa1513024","finding":"Readmissions for the targeted conditions fell from 21.5% to 17.8% between 2007 and 2015. Observation stays grew, but hospitals with bigger readmission drops did not show bigger observation growth."},{"theme":"Did readmissions fall?","cite":"Desai et al., JAMA 2016","title":"Association Between Hospital Penalty Status Under the HRRP and Readmission Rates for Target and Nontarget Conditions","url":"https://doi.org/10.1001/jama.2016.18533","finding":"Hospitals that were later penalized cut readmissions faster than others after the program was announced. The improvement leveled off once penalties began in October 2012."},{"theme":"Did readmissions fall?","cite":"MedPAC, June 2018","title":"Mandated report: The effects of the Hospital Readmissions Reduction Program","url":"https://www.medpac.gov/wp-content/uploads/import_data/scrape_files/docs/default-source/reports/jun18_ch1_medpacreport_rev_nov2019_v2_note_sec.pdf","finding":"Congress's advisers concluded the program lowered readmissions without a material rise in ER visits, observation stays, or deaths, saving Medicare roughly $1.5 billion a year by 2016. They suggested accounting for hospitals' low-income patient share."},{"theme":"Was the drop real?","cite":"Ibrahim et al., JAMA Intern Med 2018","title":"Association of Coded Severity With Readmission Reduction After the HRRP","url":"https://doi.org/10.1001/jamainternmed.2017.6148","finding":"In this research letter, about 63% of the risk-adjusted decline was statistically attributable to rising coded severity at exposed hospitals. The authors could not tell whether the coding change was appropriate."},{"theme":"Was the drop real?","cite":"Sabbatini et al., JAMA Netw Open 2022","title":"Accounting for the Growth of Observation Stays in the Assessment of Medicare's HRRP","url":"https://doi.org/10.1001/jamanetworkopen.2022.42587","finding":"Counting observation stays as returns cut the measured drop for targeted conditions from 1.48 to 0.66 points. The program's extra effect over non-targeted conditions was no longer statistically significant."},{"theme":"Was the drop real?","cite":"Wright et al., Health Serv Res 2023","title":"Medicare's hospital readmissions reduction program and the rise in observation stays","url":"https://doi.org/10.1111/1475-6773.14142","finding":"Observation use rose only slightly faster for targeted conditions after the program began; most of the growth tracked other forces, such as billing audits."},{"theme":"Was the drop real?","cite":"Ody et al., Health Aff 2019","title":"Decreases In Readmissions Credited To Medicare's Program To Reduce Hospital Readmissions Have Been Overstated","url":"https://doi.org/10.1377/hlthaff.2018.05178","finding":"A change in billing standards at the same time let hospitals list more diagnoses per claim, which lowered risk-adjusted readmission rates. Accounting for it cut the measured decline for targeted conditions by 48%, and after further adjustment that decline matched two control groups."},{"theme":"Were patients harmed?","cite":"Gupta et al., JAMA Cardiology 2018","title":"Association of HRRP Implementation With Readmission and Mortality Outcomes in Heart Failure","url":"https://doi.org/10.1001/jamacardio.2017.4265","finding":"In a registry of 416 participating hospitals, with a before/after comparison and no control group, 30-day readmissions fell from 20.0% to 18.4% while 30-day deaths rose from 7.2% to 8.6% after penalties began. The authors called for confirmation."},{"theme":"Were patients harmed?","cite":"Wadhera et al., JAMA 2018","title":"Association of the HRRP With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, AMI, and Pneumonia","url":"https://doi.org/10.1001/jama.2018.19232","finding":"Across 8.3 million hospitalizations, deaths within 30 days after discharge rose for heart failure and pneumonia, mostly among patients who were never readmitted, and fell for heart attack. Deaths within 45 days of admission did not change significantly. The authors called for more research."},{"theme":"Were patients harmed?","cite":"Khera et al., JAMA Netw Open 2018","title":"Association of the HRRP With Mortality During and After Hospitalization for AMI, Heart Failure, and Pneumonia","url":"https://doi.org/10.1001/jamanetworkopen.2018.2777","finding":"Looking at the same three conditions, this team found no change in mortality trends when the program was announced or started. Heart failure deaths after discharge were already rising before the program."},{"theme":"Were patients harmed?","cite":"Dharmarajan et al., JAMA 2017","title":"Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge","url":"https://doi.org/10.1001/jama.2017.8444","finding":"In a hospital-level study of Medicare patients with heart failure, heart attack, or pneumonia from 2008 to 2014, hospitals whose readmissions fell tended to see deaths after discharge fall too, though the link was weak. The authors said this does not support rising deaths from cutting readmissions."},{"theme":"Is it fair to safety-net hospitals?","cite":"Joynt Maddox et al., JAMA Intern Med 2019","title":"Association of Stratification by Dual Enrollment Status With Financial Penalties in the HRRP","url":"https://doi.org/10.1001/jamainternmed.2019.0117","finding":"Comparing actual FY2018 and FY2019 penalties, the peer-group change cut penalties about $22 million for hospitals with the most dual-eligible patients and raised them about $12 million for those with the fewest."},{"theme":"Is it fair to safety-net hospitals?","cite":"Shashikumar et al., Health Affairs 2022","title":"Three-Year Impact Of Stratification In The Medicare HRRP","url":"https://doi.org/10.1377/hlthaff.2021.01448","finding":"After three years, peer grouping lowered penalties modestly at hospitals with many dual-eligible, rural, Black, or Hispanic patients. The authors called it a modest step toward equity."},{"theme":"What changes with Medicare Advantage?","cite":"Oseran et al., Ann Intern Med 2023","title":"Effect of Medicare Advantage on Hospital Readmission and Mortality Rankings","url":"https://doi.org/10.7326/M22-3165","finding":"When Medicare Advantage patients were added to the measures, about one in four top-ranked hospitals dropped to a lower rank, while a similar share of the lowest-ranked rose. Hospitals with more Medicare Advantage patients tended to improve. Under CMS's FY2026 rule, FY2027 is the first payment year built this way."},{"theme":"What changes with Medicare Advantage?","cite":"Chopra et al., JAMA Netw Open 2026","title":"Hospital Readmission Reduction Program Penalties for Hospitals With High Medicare Advantage Penetration","url":"https://doi.org/10.1001/jamanetworkopen.2025.54972","finding":"Using FY2019–FY2022 data, adjusting for local Medicare Advantage enrollment would have shifted roughly $284–297 million a year in penalties among 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