Readmission Rate
The percentage of patients who return to the hospital within 30 days of discharge for the same or related condition, a key quality metric tracked by CMS.
Readmission Rate is a term from U.S. hospital cost and quality reporting — the field that produces the CMS Hospital Compare program, the Medicare Inpatient Payment files, and the patient-facing tools built on top of them. The definition below covers what the term means in CMS files, what it does not mean, and how it interacts with the other measures CMS publishes. On the LakeQuality value rubric, Readmission Rate is one of the inputs (directly or indirectly) to the combined cost-and-quality grade. Understanding how the term is computed at CMS — what counts and what does not — is part of reading hospital pages defensibly.
Each hospital page on LakeQuality surfaces the specific Readmission Rate value for that facility (when CMS reports one), so the general definition here translates into a concrete data point on the per-hospital pages you actually use.
How It Works
Hospital readmissions are both a quality and a cost concern, since unplanned readmissions within 30 days of discharge often signal premature discharge, poor discharge planning, inadequate patient education, weak follow-up care coordination, or unresolved clinical issues. Nationally, the all-cause 30-day hospital readmission rate runs near 15-16% and costs Medicare approximately $26 billion annually, of which CMS estimates $17 billion is potentially avoidable. The Hospital Readmissions Reduction Program (HRRP), established by the ACA and effective FY2013, penalizes hospitals with excess risk-adjusted readmissions for six conditions: acute myocardial infarction (AMI), heart failure (HF), pneumonia, chronic obstructive pulmonary disease (COPD), elective total hip or knee arthroplasty (THA/TKA), and coronary artery bypass graft (CABG). Penalties are calculated using three years of Medicare claims data and applied as a reduction of up to 3% on all Medicare inpatient payments for the following fiscal year. In FY2024, approximately 2,300 hospitals received penalties totaling about $320 million, with 39 hospitals hitting the maximum 3% reduction. The average penalty ran 0.43% of base operating payments. Hospitals have responded by investing heavily in transitional care: post-discharge phone calls within 48 hours, home visits by advanced practice nurses, discharge medication reconciliation, scheduled follow-up appointments before discharge, and community partnerships with skilled nursing facilities. The Care Transitions Intervention and the BOOST program have demonstrated readmission reductions of 20-30%. Readmission rates are risk-adjusted for patient age, sex, and comorbidities but not for socioeconomic status, a long-standing critique that led CMS to add peer group stratification starting FY2019.
Related Terms
- Hospital Readmission Penalty (HRRP), A Medicare payment penalty of up to 3% applied to hospitals with excess 30-day readmissions for six tracked conditions, administered through the Hospital Readmissions Reduction Program.
- CMS Star Rating (Hospital Overall Rating), A 1-to-5 star rating assigned by CMS to each hospital based on 46+ quality measures, covering mortality, safety, readmissions, patient experience, and timely care.
- Mortality Rate (Hospital), The rate of patient deaths within 30 days of hospital admission for specific conditions, risk-adjusted to account for differences in patient severity.
- Value Score, HospitalCostData's proprietary A-F grade combining price (40%), quality rating (40%), and patient outcomes (20%), measuring whether a hospital delivers good care at a fair price.
- Hospital-Acquired Condition (HAC) Reduction Program, A CMS program that reduces Medicare payments by 1% for the quartile of hospitals with the highest rates of hospital-acquired conditions, including infections and preventable injuries.
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About This Definition
This definition is part of the HospitalCostData Hospital Pricing Glossary, 47 terms explaining hospital costs, quality ratings, and healthcare billing. Written for patients, journalists, researchers, and healthcare professionals.