FY 2023 IPPS Final Rule: Hospital Readmissions Reduction Program (HRRP) Supplemental Data 						
Variable Name	Variable Description 					
Hospital CCN	Medicare Provider Number or CMS Certification Number (CCN). The file only includes open subsection (d) hospitals with measure results for at least one measure in the Hospital Readmissions Reduction Program. Maryland hospitals and hospitals that are not open as of the October 2022 public reporting open/closed list (published on 5/11/2022) are excluded. 					
Payment adjustment factor 	"The FY 2023 payment adjustment factor is based on discharges between July 1, 2018 to December 1, 2019 and July 1, 2020 to June 30, 2021 (that is, the data period used for the FY 2023 Hospital Readmissions Reduction Program). The methodology to calculate the payment adjustment factor was finalized in the IPPS/LTCH PPS Final Rule and is based on Excess Readmission Ratios (ERR) for five conditions or procedures: Acute Myocardial Infarction (AMI), Chronic Obstructive Pulmonary Disease (COPD), Heart Failure (HF), Coronary Artery Bypass Graft (CABG) surgery, and elective primary Total Hip/Total Knee Arthroplasty (THA/TKA). The pneumonia measure results do not contribute to FY 2023 Hospital Readmissions Reduction Program payment reduction calculations (see note in row 16, below the table). The payment adjustment factor corresponds to the percentage a hospital's payments will be reduced. The minimum payment adjustment factor is 0.97 (that is, 3% maximum payment reduction). The maximum payment adjustment factor is 1 (that is, no payment reduction). Hospitals with higher payment adjustment factors have lower payment reductions. "					
Payment reduction percentage	The payment reduction percentage is the percentage a hospital's payments will be reduced based on its performance in the program. The minimum payment reduction percentage is 0% and the maximum payment reduction percentage is 3%.					
Dual proportion	"The dual proportion is the proportion of Medicare fee-for-service (FFS) and managed care stays in a specific hospital, where the patient was dually eligible for Medicare and full Medicaid benefits during the data period used for the FY 2023 Hospital Readmissions Reduction Program (July 1, 2018 to December 1, 2019 and July 1, 2020 to June 30, 2021). CMS identifies dual eligible status using data from the Master Beneficiary Summary File, which is sourced from the State Medicare Modernization Act files. Stays for dual eligible patients are stays where the patient was eligible for both Medicare and full Medicaid benefits for the month the beneficiary was discharged from the hospital. For beneficiaries who die in the month of discharge, dual-eligibility status is determined using the previous month. CMS identifies Medicare FFS and managed care stays using Medicare Provider Analysis and Review (MedPAR) files from FY 2018 to FY 2021."					
Peer group assignment	"Hospitals are sorted into five peer groups, or quintiles, based on their dual proportion. Hospital peer group assignments are numbered 1 through 5. Hospitals in the first peer group (peer group assignment 1) have the lowest dual proportions and hospitals in the fifth peer group (peer group assignment 5) have the highest dual proportions relative to other HRRP hospitals. As of FY 2019, hospital performance for each measure is assessed relative to hospitals within the same peer group."					
Neutrality modifier	The neutrality modifier is the calculated value that makes the total savings to the Medicare program generated under the peer grouping methodology (used from FY 2019 and onward) roughly equal to the total savings generated under the non-peer grouping methodology (used from FY 2013 to FY 2018).					
Number of eligible discharges 	"The number of eligible discharges for a measure cohort during the FY 2023 data period (discharges from July 1, 2018 to December 1, 2019 and July 1, 2020 to June 30, 2021).  Measures with fewer than 25 eligible discharges are not eligible to contribute to the payment reduction. The payment adjustment factor formula will not include these measures.
                                                                                                                                                                                                                                                                                                                                                                                                          This field shows a ""."" if a hospital has no eligible discharges for a measure."					
ERR	"The ratio of the predicted readmission rate to the expected readmission rate for a given measure. CMS uses the ERR to assess hospital performance in the Hospital Readmissions Reduction Program. 

This field shows a ""."" if a hospital has no eligible discharges for a measure."					
Peer group median ERR	The median ERR for the hospital’s peer group for the measure. The peer group median ERR is the threshold CMS uses to assess excess readmissions relative to other hospitals within the same peer group. All hospitals in the same peer group will have the same peer group median ERR for a measure.					
Penalty indicator	"If the penalty indicator equals ""Y"", the hospital has 25 or more eligible discharges and an ERR greater than the peer group median ERR. When the penalty indicator equals ""Y"", the ERR will contribute to the payment adjustment factor formula and the hospital could receive a payment reduction. If the hospital has fewer than 25 eligible discharges or the ERR is less than the peer group median ERR for that measure, the penalty indicator equals ""N"", and the ERR will not contribute to the payment adjustment factor formula."					
DRG payment ratio	"The ratio of total base operating diagnosis-related group (DRG) payments for each measure among all base operating DRG payments. This is the weight attributed to excess readmissions for each measure (that is, ERR minus peer group median ERR) in the payment adjustment factor formula. The data source to identify the DRG payment ratio is the FY 2018-FY 2021 MedPAR files. 

This field shows a ""."" if a hospital has no eligible discharges for a measure.

If a hospital has few eligible discharges for a given measure, the ratio of DRG payments to total payments may be missing. This is the result of minor discrepancies between the data sources CMS used to identify eligible discharges and calculate payments. In these cases, the number of eligible discharges is too small for the ERR for that measure to contribute to the hospital's payment adjustment formula. 
"					
"Note: As clarified in the FY 2022 IPPS/LTCH PPS final rule, CMS will exclude claims from ERR calculations and DRG payment ratio calculations for hospitals with approved individual extraordinary circumstance exceptions (ECEs) for any quarter during the performance period. Data will not be removed from dual proportion calculations or the 1-year data period used to calculate the neutrality modifier."						
"As discussed in the FY 2022 IPPS/LTCH PPS final rule, CMS will not use claims data representing Q1 and Q2 2020 in its calculations for the Hospital Readmissions Reduction Program (86 FR 45260 - 45261). The performance period in this report has been updated to reflect this policy. The readmission measures used in the Hospital Readmissions Reduction Program identify readmissions within 30 days of each index stay; therefore, the performance period for the Hospital Readmissions Reduction Program will also not use claims data representing the 30 days before January 1, 2020. The FY 2023 performance period for the Hospital Readmissions Reduction Program is July 1, 2018 to December 1, 2019 and July 1, 2020 to June 30, 2021, so that no claims from Q1 and Q2 2020 are used in the measure or program calculations."						
"As finalized in the FY 2022 IPPS/LTCH PPS final rule, the pneumonia readmission measure is suppressed in FY 2023 Hospital Readmissions Reduction Program payment reduction calculations due to COVID-19's substantial impact on the measure (86 FR 45254-45256). The pneumonia readmission measure results do not contribute to FY 2023 Hospital Readmissions Reduction Program payment reduction calculations and are not included in this file."						
End of worksheet						
