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January 23/30, 2013

Pediatric Readmissions as a Hospital Quality Measure

Author Affiliations

Author Affiliations: Division of Inpatient Medicine, Department of Pediatrics, University of Utah Health Sciences Center, and Primary Children's Medical Center and Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City (Dr Srivastava); Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia (Dr Keren); and Executive Council, Pediatric Research in Inpatient Settings (PRIS) Research Network (Drs Srivastava and Keren).

JAMA. 2013;309(4):396-398. doi:10.1001/jama.2012.217006

On October 1, 2012, the Centers for Medicare & Medicaid Services began penalizing hospitals for high readmission rates as part of the US Patient Protection and Affordable Care Act's Hospital Readmission Reduction Program (HRRP).1 Hospitals that have been designated high readmission outliers have had their Medicare payments reduced by 1% for adult patients discharged with congestive heart failure, pneumonia, and acute myocardial infarction. Penalties will increase to 3% by 2015, and other conditions will be added to the list for which those penalties apply.2 This focus on reducing 30-day readmission rates is part of a larger strategy to help control rising health care costs. While critics have complained that the HRRP is a blunt instrument that fails to account for distinguishing characteristics of hospitals and the patient populations that they serve,3 the Supreme Court's recent decision ensures that the Affordable Care Act's mandates will be implemented.4 To date, hospitals that care for children have not been targeted by the HRRP, but often policies that start in adult hospitals eventually migrate to hospitals that care for children. If that happens, then the study by Berry and colleagues5 in this issue of JAMA will take on substantial significance.