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    Research Letter
    Health Policy
    April 28, 2020

    Assessment of Completeness of Hospital Readmission Rates Reported in Medicare Advantage Contracts’ Healthcare Effectiveness Data and Information Set

    Author Affiliations
    • 1Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
    • 2Providence VA Medical Center, Providence, Rhode Island
    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.