Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) Rate for the Merit-Based Incentive Payment System Groups

The 30-day Hospital-Wide, All-Cause Unplanned Readmission (HWR) Rate for the Merit-Based Incentive Payment System (MIPS) Groups measure is a risk-standardized readmission rate for beneficiaries age 65 or older who were hospitalized and experienced an unplanned readmission for any cause to a short-stay acute-care hospital within 30 days of discharge. The measure attributes readmissions to up to three MIPS participating clinician groups, as identified by their Medicare Taxpayer Identification Number (TIN) and assesses each group’s readmission rate. This clinician group-level, risk-standardized, all-cause unplanned readmission measure is a re-specified version of the hospital-level measure, “Hospital-wide Allcause Unplanned Readmission Measure” (NQF 1789), which is currently reported within the Inpatient Quality Reporting (IQR) program. This measure will replace the existing All-Cause Readmission (ACR) measure currently in use in QPP.

Date Reviewed: April 1, 2021

Measure Info

MIPS 479
Measure Type
Measure Steward
Centers for Medicare and Medicaid Services
Clinical Topic Area

Care Setting
Outpatient Services
Data Source
Medicare beneficiary enrollment data
Medicare FFS claims (Parts A and B)

ACP does not support MIPS 479/Adaptation of NQF 1789 - "Hospital-Wide, 30-Day, All-Cause Unplanned Readmission (HWR) for MIPS Groups" for application at the actual/intended level of analysis: “Group Practice” because of uncertain validity. The importance and impact of the measure is in question and there is no evidence to demonstrate its impact on health outcomes, at the group practice level.  There were also some other significant concerns regarding gaming that has been documented with the hospital level measure (i.e., putting patients in observation status for a few days so they won’t count as a readmission).  One way to mitigate this concern is to incorporate an exclusion related to excess days of acute care, which is an approach that has been well validated in cardiac care.  Another issue relates to the measure’s reliability particularly with volumes below 200.  This needs to be accounted for in some way with an exclusion or a low volume threshold when implemented.  The risk adjustment was marginal and did not include social determinants or measures of income.  Finally, there are concerns about the attribution approach and the multiple attribution model.  This approach can lead to bias against attribution groups that are not aligned financially.