Readmission Reduction Incentive Program (RRIP)


The Maryland Readmissions Reduction Incentive Program (RRIP) incentivizes hospitals to reduce avoidable readmissions by linking rewards and penalties to improvements in readmissions rates, and to attainment of relatively low readmission rates. Readmissions occur when a patient is discharged from a hospital and is admitted to any hospital within 30 days of the discharge. Preventable hospitals readmissions may result from complications from previous hospitalization and/or inadequate care coordination, and generate substandard care quality for patients and unnecessary costs. The RRIP compares all-payer readmission rates adjusted for the severity of illness (casemix) for all types of inpatient visits for the calendar year with the rates in the base year to calculate improvement, and reviews the all-payer readmission rates adjusted for casemix and out-of-state ratios to calculate attainment.


Most hospitals in the nation are subject to penalties based on their performance on certain diagnosis-specific Medicare readmissions as part of the federal Medicare Hospital Readmissions Reduction Program (HRRP). The Commission previously encouraged reductions in unnecessary readmissions under the Admission-Readmission Revenue (ARR) program. The current episode-based payment model encourages hospitals to reduce readmissions, and enables hospitals to keep the savings from such reductions.  To ensure savings are passed on the public, the Commission passes some savings to payers via the Potentially Avoidable Utilization (PAU) Savings Program. 

Current Readmissions Reduction Incentive Program (RRIP) 

On January 1, 2014 the State of Maryland entered into a new All-Payer Model demonstration contract with the Center for Medicare and Medicaid Innovation (CMMI).  Among other provisions of this contract, the State is required to reduce the statewide Medicare fee-for-service readmission rate to the national Medicare readmission rate level over the five-year contract term and make yearly progress towards reducing this gap. 

In order to meet the new Model requirements, the Commission approved the Readmissions Reduction Incentive Program (RRIP) in April 2014 to increase the incentives to reduce unnecessary readmissions. The RRIP began to impact hospital revenue starting in Rate Year 2016, with the first performance year of Calendar Year 2014. The initial program focused on providing a set amount of rewards for strong reductions in readmission rates. As the program evolved, penalties were added, along with sliding scale payment adjustments that recognized the variation in performance. For the Calendar Year 2016 performance year, the Commission altered the methodology to measure hospital performance as the better of attainment (rewarding high-performing hospitals) or improvement to determine payment adjustments. This adjustment to the methodology strengthens incentives for low-performing hospitals to improve and avoids penalizing high-performing hospitals. 

Key program components of RRIP methodology:​

   30-Day Readmissions:
  • ​​Measure readmissions across hospitals in Maryland using the CRISP (Chesapeake Regional Information System for our Patients) unique patient identification numbers 
  • Adjust all-payer readmission rates for patient case-mix and severity of illness
  • Exclude planned admissions from the program using CMS logic with Maryland-specific adjustments (i.e., all deliveries are considered planned)

  RRIP Disparity Program:

Maryland hospitals are able to earn a reward of up to 0.5% of inpatient revenue by​ reducing socioeconomic disparities in readmission. Program details are contained in the RRIP policies for RY2022 and later years. The program gauges patient-level socioeconomic status with the Patient Adversity Index (PAI). A memo describing steps required to append PAI values to hospital EHR and claims data systems is provided here. A related data file containing PAI values for all unique combinations of race, Medicaid status and Area Deprivation Index is provided here​.

Key program components of RRIP scoring:

  • ​Measure hospital performance as the better of attainment) or improvement to determine payment adjustments.
  • Adjust attainment scores to account for readmissions occurring at non-Maryland hospitals.
  • Scale rewards and penalties for attainment based on relative performance to statewide attainment benchmark and for improvement based on relative performance to statewide minimum improvement target.

Key RRIP Policy Documents

RY 2025

​Communications and Memos ​ ​
Document TitleDate
​Final Policy
RY 2025 RRIP Final Policy
​Jan 11, 2023

RY 2025 RRIP Memo

​Feb 28, 2023

RY 2024

​Communications and Memos ​ ​
Document TitleDate
RY 2024 RRIP Memo
​Aug 2, 2022

RY 2023

​Communications and Memos ​ ​
Document Title Date
​Final Policy RY 2023 RRIP Final Policy Jan 13, 2021
Memo​ RY 2023 RRIP Memo​ (additional appendix info) ​May 18, 2021

RY 2022

​Communications and Memos ​ ​
Document Title Date
​Final Policy RY 2022 RRIP Final Policy
Mar 17, 2020
Memo​ ​​RY 2022 RRIP Memo ​Apr 24, 2020
​Revenue Adjustment RY 2022 RRIP Scaling​ ​Jun 30, 2021

RY 2021

​Communications and Memos ​ ​
Document Title Date
​Final Policy Final RY 2021 RRIP Policy​
Apr 24, 2019
Memo​ RY 2021 RRIP Memo ​Apr 24, 2020
Data Workbooks​​ ​ ​
Performance Period Data RY 2021 Readmissions Final Summary
​June 02,2020
​Revenue Adjustments RY 2021 RRIP Scaling
Updated June 13,2020​

RY 2020

​Communications and Memos ​ ​
Document Title Date
​Final Policy Final RY 2020 RRIP Policy
Mar 14, 2018
Memo​ ​​RY 2020 RRIP Memo ​Apr  11, 2018
Data Workbooks​​ ​ ​
Performance Period Data​ RY 2020  Readmissions Final Summary  ​May 29, 2019
​Revenue Adjustments RY 2020 RRIP Scaling ​May​ 29, 2019​

RY 2019

​Communications and Memos ​ ​
Document Title Date
​Final Policy Final RRIP RY 2019.pdf​ ​May 10, 2017
Memo​ ​2017-06-21 RY 2019 RRIP Memo.pdf​​ Jun 21, 2017

* Designated hospital employees can access mid-year data through the CRISP Reporting Services (CRS) Portal. For non-hospital interested parties, this data is available upon request, please contact HSCRC Quality at hscrc.quality@maryland.gov​.

RY 2018

​Communications and Memos ​ ​
Document Title Date
​Final Policy RY 2018 RRIP Final Policy.pdf ​Ju​n 08, 2016
Memo​ ​​Readmissions Reduction Incentive Program (RRIP) Policy for Rate Year (RY) 2018 and RY 2017 Updates.pdf ​Jun 30, 2016
Data Workbooks​​ ​ ​
​Results RY 2018 Quality Program Revenue Adjustment ​​May 12, 2017
​Calculation Sheet RRIP-RY 2018 Calculation Sheet.xlsx ​Jul 13, 2016

RY 2017

​Communications and Memos ​ ​
Document Title Date
​Final Policy RY 2017 RRIP Final Policy.pdf
For additional changes to RY 2017 policy, see RY 2018 Final Policy
​Mar 11, 2015
Memo​ RY 2017 RRIP Policy Memo.pdf​

RY17 Quality Program and PAU Results Memo Rev. 06-22-2016.pdf
​Apr 02, 2015

Jun 22, 2016
Data Workbooks​​ ​ ​
Results RY17 Readmission Reduction Incentive Program Results.xlsx ​​Jul 21, 2016
Revenue Adjustment RY17 Readmission Reduction Incentive Program Scaling.xlsx ​Jul 26, 2016

RY 2016

​Communications and Memos ​ ​
Document Title Date
​Final Policy RY 2016 RRIP Policy.pdf​ ​Apr 09, 2014
Memo​ Readmission-FY-2016-Memo-05-09-FINAL.pdf ​May 09, 2014
Data Workbooks​​ ​ ​
Results Readmission-Reduction-Progam-Jan-December-2014-Final.xlsx ​​Dec 23, 2015

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