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Kim D, Makineni R, Panagiotou OA, Trivedi AN. Assessment of Completeness of Hospital Readmission Rates Reported in Medicare Advantage Contracts’ Healthcare Effectiveness Data and Information Set. JAMA Netw Open. 2020;3(4):e203555. doi:10.1001/jamanetworkopen.2020.3555
The Centers for Medicare & Medicaid Services (CMS) pays $6 billion in annual bonus payments to Medicare Advantage (MA) contracts that achieve 4 or more stars on a 5-star quality rating system.1 The CMS derives star ratings from 46 measures, including a 30-day hospital readmission measure reported by MA contracts to the Healthcare Effectiveness Data and Information Set (HEDIS). Limited analyses exist regarding the accuracy of reporting of MA contracts’ HEDIS quality data.2,3 Using CMS’s first-ever released MA encounter data, we assessed the agreement between the readmission rates reported by MA contracts and readmission rates calculated from their encounter data.
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