Readmission Reduction Incentive Program (RRIP)
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Overview
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.
Background
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
RY 2021
RY 2020
RY 2019
* 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
RY 2017
RY 2016
