The Hospital Readmissions Reduction Program
Authorized under Section 3025 of the Affordable Care Act, HRRP requires CMS to reduce payments to acute care hospitals with excess readmissions. The program measures 30-day risk-standardized readmission rates for six specific conditions and compares each hospital's performance against a national baseline.
The maximum penalty is 3% of all Medicare inpatient payments — not just payments for the penalized conditions. A hospital receiving $20 million in annual Medicare inpatient payments faces up to $600,000 in potential penalties. In practice, the average penalty runs approximately $217,000 per affected hospital.
More than 2,500 hospitals are penalized in a typical HRRP program year. Vizier calculates your current risk-standardized readmission rates by condition and models your projected penalty before CMS publishes its annual determination.
LACE Score: Predicting Who Returns Within 30 Days
The LACE index (0–19 scale) predicts 30-day readmission and death after hospital discharge. Scores of 10 or higher indicate high risk. Vizier calculates LACE for every discharge automatically from your ADT and clinical data.
Length of Stay
Longer inpatient stays correlate with higher readmission risk. Vizier calculates the LACE L-score (1 point per day, capped at 7) for every discharge.
Acuity of Admission
Acute admissions via emergency department carry higher LACE scores than elective admissions. Acuity is captured at the point of admission.
Comorbidity of Patient
Charlson Comorbidity Index is used. Conditions including prior MI, CHF, diabetes with complications, renal disease, and malignancy add to the score.
Emergency Department Use
Number of ED visits in the 6 months prior to admission. Each visit adds points; 4+ visits in 6 months carries the maximum score.
What Happens After Discharge Drives Readmission Risk
Medication non-compliance is the leading driver of preventable readmissions — accounting for approximately 38% of avoidable returns. Patients who do not fill discharge prescriptions within 72 hours are significantly more likely to return within 30 days.
The 7-day follow-up benchmark: industry best practice requires scheduling a follow-up appointment within 72 hours of discharge and completing it within 7 days. Vizier tracks this compliance rate at the provider and unit level, flags patients who have not yet scheduled, and models the readmission rate impact of closing the gap.
The CMS 30-day readmission window covers any unplanned inpatient readmission within 30 days of discharge, regardless of diagnosis at readmission. Planned readmissions (per the CMS Planned Readmission Algorithm) are excluded from the measure calculation.
Identify Variation Before CMS Does
Readmission rates vary significantly by attending physician, discharge unit, and care team. Vizier surfaces provider-level readmission rates, stratified by condition and risk score, so performance improvement conversations are grounded in data — not anecdote.
Discharge Planning Gap Analysis
Identifies patients discharged without completed medication reconciliation, follow-up appointments, or patient education documentation.
Root Cause Attribution
Tags each readmission with primary cause: medication issue, follow-up failure, social determinants, disease progression, or surgical complication.
Condition-Specific Rate Trending
Track your risk-standardized readmission rate for each HRRP condition month over month, compared to national median and top-quartile benchmarks.
Calculate Your HRRP Penalty Exposure
Upload your discharge data and see your current 30-day readmission rates by condition, your projected HRRP penalty, and which patient segments represent the highest intervention opportunity.