Key Points:
- The calculation of 30-day hospital-wide all-cause readmission rates varies significantly across organizations due to differences in inclusion/exclusion criteria, data sources, and operational definitions. For example, the Centers for Medicare & Medicaid Services (CMS) uses both encounter and claims data, while the California Department of Health Care Access and Information (HCAI) and the Hospital Quality Institute (HQI) rely on patient-level encounter data only.
- HQI’s adherence to CMS methodologies results in higher alignment with national benchmarks, whereas HCAI’s broader criteria — such as counting all readmissions within 30 days and crediting readmitting facilities — lead to inflated statewide rates and potential inconsistencies for benchmarking.
- HQI’s methodology, closely mirroring CMS standards, supports standardized benchmarking and state-level policy decisions, whereas HCAI’s approach, while operationally useful, lacks consistency for broader comparative analyses.
To learn about the variations in HWR rate calculations across organizations, how differences in data sources, inclusion criteria, and methodologies impact reported rates, and the implications for benchmarking, read the full analysis paper.