Georgia Medicare Readmissions Reduction 2026 Guide

The Hospital Readmissions Reduction Program (HRRP) is one of the most consequential and most controversial quality-based payment programs in Medicare. Authorized at Section 1886(q) of the Social Security Act through Section 3025 of the Affordable Care Act of 2010 (Public Law 111-148) and effective fiscal year 2013, HRRP reduces Medicare payments to hospitals with higher-than-expected 30-day all-cause readmission rates for six condition-specific measures: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), chronic obstructive pulmonary disease (COPD), elective total hip arthroplasty and total knee arthroplasty (THA/TKA), and coronary artery bypass graft (CABG) surgery. The maximum payment reduction is 3 percent of base operating Inpatient Prospective Payment System payments, applied annually based on three-year rolling measurement periods.

For Georgia, HRRP is enormous and consequential. Every major IPPS hospital in the state, including Grady Memorial Hospital, Emory University Hospital, Emory University Hospital Midtown, Northside, Piedmont Atlanta, Children's Healthcare of Atlanta, Memorial Health Savannah, AU Medical Center, Phoebe Putney Memorial Hospital, Atrium Health Floyd, Northeast Georgia Medical Center, Wellstar Kennestone, Wellstar Cobb, and dozens of others, participates in HRRP and faces annual readmission rate measurement, penalty determination, and payment adjustment. Critical Access Hospitals (rural Georgia CAHs with 25 or fewer beds) are excluded from HRRP, reflecting their cost-based reimbursement framework. Maryland hospitals are excluded due to Section 1814(b)(3) of the Social Security Act demonstration arrangements. Cancer hospitals and hospitals with insufficient case volume are also excluded.

The methodology is sophisticated and technical. Yale Center for Outcomes Research and Evaluation (Yale CORE) developed and maintains the HRRP measures using hierarchical logistic regression risk adjustment that accounts for patient age, gender, comorbidities, and clinical severity. The methodology produces a Risk-Standardized Readmission Rate (RSRR) and an Excess Readmission Ratio (ERR = Predicted / Expected) for each measure for each hospital. Hospitals with ERR above 1.0 may face penalty.

Section 15002 of the 21st Century Cures Act of 2016 (Public Law 114-255) fundamentally reformed HRRP by adding peer group stratification effective fiscal year 2019. Research and advocacy had demonstrated that safety-net hospitals (those serving high proportions of dual eligible Medicare-Medicaid beneficiaries) faced disproportionate penalty concentration because the original HRRP risk adjustment did not account for socioeconomic status. The peer group reform divided hospitals into five groups based on dual eligible patient proportion and compared each hospital's performance to median performance within its peer group rather than to national average. For Georgia hospitals serving high dual eligible proportions (Grady, Memorial Savannah, Phoebe Putney), the peer group reform was substantial and significantly reduced penalty exposure.

This guide is for Georgia hospital administrators, quality directors, care transitions teams, healthcare consultants, and Medicare beneficiaries. We explain the Section 1886(q) framework, the six condition-specific measures, the methodology, peer group stratification, exclusions, care transitions programs (Project RED, Project BOOST, Transitional Care Model, INTERACT, Care Transitions Intervention), Georgia Medical Care Foundation Quality Innovation Network support, MedPAC analyses, AHA litigation, and how Georgia hospitals approach HRRP compliance and improvement.

The statute: Section 1886(q) and Section 3025 ACA

The HRRP was created by Section 3025 of the Affordable Care Act of 2010, which added Section 1886(q) to the Social Security Act. The statute directs CMS to:

"... reduce the amount of payment ... to applicable hospitals with respect to applicable conditions that the Secretary determines have excess readmissions."

The original statute set:

• Effective date: FY 2013
• Maximum reduction: 1% (FY 2013), 2% (FY 2014), 3% (FY 2015 and subsequent)
• Initial measures: AMI, HF, PN
• Authority for additional measures over time

Section 15002 21st Century Cures Act

Section 15002 of the 21st Century Cures Act of 2016 (Public Law 114-255) reformed HRRP by adding peer group stratification. The change responded to substantial research and advocacy showing that safety-net hospitals faced disproportionate penalty concentration.

Section 15002 added Section 1886(q)(8) authorizing the peer group methodology. The reform was effective FY 2019.

Statutory rationale

Congress recognized that:

• Unplanned readmissions are often preventable
• Readmissions represent costs to Medicare and disruption for beneficiaries
• Hospitals have substantial influence over readmission risk through discharge planning, care coordination, and post-discharge follow-up
• Financial incentive could drive quality improvement
• Public reporting could create reputational incentive

Statutory limitations

Congress also recognized:

• Some readmissions are unavoidable
• Risk adjustment is essential
• Safety-net hospitals serve sicker patients with more social complexity
• Peer group comparison addresses safety-net hospital concerns

The six condition-specific measures

HRRP measures six conditions, each with separate measurement and penalty calculation:

Acute Myocardial Infarction (AMI)

• Patients admitted with primary diagnosis of AMI (heart attack)
• 30-day all-cause readmission rate
• Established since FY 2013

Heart Failure (HF)

• Patients admitted with primary diagnosis of heart failure
• Largest measure by patient volume
• Established since FY 2013

Pneumonia (PN)

• Patients admitted with pneumonia diagnosis
• Definition has been expanded over time (sepsis with secondary pneumonia, aspiration pneumonia)
• Established since FY 2013

Chronic Obstructive Pulmonary Disease (COPD)

• Patients admitted with COPD exacerbation
• Added in FY 2015

Total Hip and Total Knee Arthroplasty (THA/TKA)

• Elective primary THA/TKA admissions
• Added in FY 2015
• Different patient population (primarily elective surgical)

Coronary Artery Bypass Graft (CABG)

• CABG surgery admissions
• Added in FY 2017
• Cardiac surgery patients

Measure addition over time

CMS may add additional measures through rulemaking. New measures must be evidence-based and demonstrate substantial readmission burden.

The methodology

Yale CORE measure development

Yale Center for Outcomes Research and Evaluation developed the HRRP measures under CMS contract. The methodology is consistent across measures and has been refined over time.

30-day all-cause readmission definition

• 30 days following hospital discharge
• All-cause (not just same diagnosis)
• Excludes planned readmissions (specific list of planned procedures)
• Excludes same-day readmissions
• Excludes admissions to non-acute facilities
• Includes readmissions to any hospital (not just the index hospital)

Hierarchical logistic regression risk adjustment

For each measure, Yale CORE develops a risk adjustment model that accounts for:

• Patient age
• Patient gender
• Comorbidities (identified through ICD codes from current and prior admissions)
• Severity indicators
• Various clinical factors

The models are reviewed and updated periodically.

Important limitation: socioeconomic status

The risk adjustment models do not directly adjust for socioeconomic status (income, dual eligible status, race, ethnicity, education, etc.). This was a major concern that led to Section 15002 Cures Act peer group reform.

Risk-Standardized Readmission Rate (RSRR)

For each hospital and each measure:

• Predicted = number of readmissions predicted by model using hospital's patient mix
• Expected = number of readmissions expected at national average performance with same patient mix
• RSRR = (Predicted / Expected) × National Mean Rate

Excess Readmission Ratio (ERR)

• ERR = Predicted / Expected
• ERR > 1.0: hospital readmissions higher than expected for its patient mix
• ERR = 1.0: hospital performs as expected for its patient mix
• ERR < 1.0: hospital readmissions lower than expected for its patient mix

Three-year rolling measurement period

• Measures use three years of discharge data
• Each year, the oldest year drops off and the newest year is added
• More statistically stable than single-year data
• Reduces year-to-year noise

Statistical significance

Yale CORE methodology accounts for statistical uncertainty:

• Confidence intervals around ERR
• Hospitals where ERR is not statistically different from 1.0 may not face penalty
• Small-volume hospitals may have insufficient data

Payment reduction calculation

Aggregate Payments for Excess Readmissions

For each hospital with ERR > 1.0 on at least one measure, CMS calculates:

• Excess readmissions for each measure with ERR > 1.0
• Aggregate dollar value of excess readmissions
• Hospital's share of payment reduction

Maximum 3 percent reduction

• Effective FY 2015 and subsequent (FY 2013: 1%; FY 2014: 2%; FY 2015+: 3%)
• Cap on reduction applied to base operating IPPS payments
• A hospital with substantial excess readmissions on multiple measures hits the 3% cap

Application through claim payment and cost report

• Reduction applied at claim-level throughout the year
• Final settlement reflects HRRP reduction
• Worksheet E Part A of Medicare cost report applies HRRP reduction

Annual HRRP final rule

CMS publishes HRRP results annually:

• Hospital-specific ERR for each measure
• Penalty amount
• Effective dates (typically October 1 of each year)

Public availability

Hospital-specific HRRP performance is publicly available:

• Hospital Compare / Care Compare website
• CMS public datasets
• Various third-party analyses

Section 15002 Cures Act peer group stratification

Background of reform

By 2015-2016, substantial research from academic medical centers, MedPAC, AHA, AAMC, America's Essential Hospitals, and others had documented:

• Safety-net hospitals (high dual eligible proportion) had higher readmission rates
• HRRP risk adjustment did not account for socioeconomic status
• Penalty concentration at safety-net hospitals
• Equity concerns about HRRP impact on vulnerable populations

Section 15002 reform

Section 15002 of the 21st Century Cures Act of 2016 added peer group stratification to HRRP. Key features:

Five peer groups

Hospitals are divided into five peer groups based on proportion of dual eligible patients:

• Group 1: Lowest dual eligible proportion (typically <8%)
• Group 2: Lower-middle (typically 8-15%)
• Group 3: Middle (typically 15-22%)
• Group 4: Upper-middle (typically 22-30%)
• Group 5: Highest dual eligible proportion (typically >30%)

(Specific thresholds vary year-to-year and by methodology.)

Comparison within peer groups

Each hospital's ERR is compared to median ERR within its peer group:

• Hospitals above peer group median: potential penalty
• Hospitals at or below peer group median: no penalty
• Quintile distribution affects penalty calculation

Effect on safety-net hospitals

• Reduced penalty concentration at safety-net hospitals
• More equitable framework
• Did not eliminate penalties entirely (high-performing safety-net hospitals still receive no penalty; low-performing ones still face penalty within their peer group)

Effective FY 2019

The peer group methodology became effective FY 2019. Earlier years used the original methodology.

Continuing refinement

CMS has continued refining peer group methodology through annual IPPS rulemaking.

Hospitals excluded from HRRP

Critical Access Hospitals

Section 1820 of SSA. CAHs are reimbursed on cost basis under 42 CFR 413, not IPPS. Not subject to HRRP. Numerous rural Georgia hospitals are designated CAHs and excluded.

Maryland hospitals

Section 1814(b)(3) demonstration. Maryland operates a different hospital payment system through CMMI demonstration. Maryland hospitals are not subject to standard HRRP.

Cancer hospitals

Designated PPS-exempt cancer hospitals (e.g., MD Anderson, Memorial Sloan Kettering, City of Hope). Excluded from HRRP.

Hospitals with insufficient cases

Hospitals with too few cases for any given measure to produce statistically reliable measurement are excluded for that measure. Small-volume hospitals.

Religious nonmedical health care institutions

Excluded due to nature of care.

Children's Healthcare of Atlanta

Children's hospitals (CHOA, Egleston, Scottish Rite) have separate considerations. Not all HRRP measures apply because of pediatric population.

Care transitions programs

The most direct response to HRRP has been hospital implementation of care transitions programs. Multiple evidence-based models have been developed.

Project RED (Re-Engineered Discharge)

Developed by Boston University Medical Center. Eleven-step protocol focused on:

• Patient education during admission
• Medication reconciliation
• Follow-up appointment scheduling before discharge
• After-Hospital Care Plan (a personalized written document)
• Telephone follow-up after discharge

Research shows Project RED reduces readmissions in implementation studies.

Project BOOST (Better Outcomes for Older adults through Safe Transitions)

Society of Hospital Medicine program. Focuses on:

• Risk assessment using the 8P risk scale (Problem medications, Psychological problems, Principal diagnosis, Polypharmacy, Poor health literacy, Patient support, Prior hospitalization, Palliative care needs)
• Tailored interventions
• Hospital-to-home transitions
• Patient and family engagement

BOOST has been implemented at hundreds of hospitals.

Transitional Care Model (TCM)

Developed by Mary Naylor (University of Pennsylvania). Advanced practice nurse-led intervention:

• Hospital visit during admission
• Home visit within 24-48 hours of discharge
• Subsequent home visits as needed
• Phone contact between visits
• Extended follow-up (1-3 months)

TCM has substantial evidence base. Effective for chronic conditions.

INTERACT (Interventions to Reduce Acute Care Transfers)

Florida Atlantic University program. Skilled nursing facility-focused:

• Early identification of acute changes in resident condition
• Care pathways for common conditions
• Communication tools (SBAR)
• Reduces SNF-to-hospital transfers

Important for hospitals discharging to SNFs.

Coleman Care Transitions Intervention (CTI)

Developed by Eric Coleman (University of Colorado). Coaching-based:

• Coach visit during hospitalization
• Home visit within 1-2 days of discharge
• Phone contact follow-up
• Four pillars: medication self-management, dynamic patient-centered record, primary care follow-up, knowledge of red flags

Evidence-based. Particularly effective for older adults.

Hospital-developed programs

Many hospitals combine elements of various models or develop hospital-specific approaches. Common elements:

• Care coordinator (nurse, social worker)
• Medication reconciliation by pharmacist
• Follow-up appointment scheduling
• Discharge phone calls
• Coordination with primary care and skilled nursing

Implementation challenges

• Workforce requirements (nurses, social workers, pharmacists)
• Information technology integration
• Coordination across settings
• Sustaining program over time
• Quality measurement

Georgia Medical Care Foundation (GMCF) Quality Innovation Network

What is GMCF?

Georgia Medical Care Foundation is Georgia's Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for the CMS Quality Improvement Organization Program. GMCF is a nonprofit organization providing quality improvement support to Georgia healthcare providers.

Services provided

• Free technical assistance on quality improvement
• Care transitions coaching
• HRRP readmission reduction support
• Various Medicare quality programs
• HACRP improvement work
• HVBP improvement work
• Patient and family engagement

Coverage

GMCF serves Georgia hospitals, nursing homes, home health agencies, and other Medicare providers. Free services to Medicare-participating providers.

Engagement with Georgia hospitals

Many Georgia hospitals work with GMCF on care transitions, readmission reduction, and quality improvement. Specific engagements vary by hospital and project.

National QIN-QIO program

GMCF is part of national network of QIN-QIOs serving different states. Network sharing of best practices and resources.

Hospital Compare and public reporting

Care Compare website

CMS's Care Compare website (formerly Hospital Compare) provides public access to hospital quality data including:

• HRRP performance by condition
• HVBP performance
• HACRP performance
• Patient experience scores
• Many other quality metrics

Public reporting transparency

Consumers, payers, and others can see hospital-specific data. This creates reputational incentive beyond financial penalty.

Effect on hospital reputation

• Hospital marketing and patient choice
• Insurer network decisions
• Employer health plan considerations
• Local press coverage

Hospital data analytics

Most hospitals invest substantially in:

• Internal HRRP performance dashboards
• Real-time readmission tracking
• Predictive analytics for high-risk patients
• Care management workflows triggered by risk scores

Combined effects with other quality programs

A hospital's quality-based payment can be reduced through three programs simultaneously.

Hospital Value-Based Purchasing (HVBP)

Section 1886(o) of SSA. Section 3001 of ACA 2010. Different program with up to 2% withhold redistributed based on quality performance. Measures include:

• Clinical care
• Patient experience (HCAHPS)
• Safety
• Efficiency (MSPB)

A hospital can lose up to 2% (and gain depending on performance).

Hospital-Acquired Condition Reduction Program (HACRP)

Section 1886(p) of SSA. Section 3008 of ACA 2010. Different program with 1% payment reduction for bottom quartile hospitals on HAC measures. Measures include:

• CDC NHSN healthcare-associated infections (CLABSI, CAUTI, SSI, MRSA, C. diff)
• PSI 90 patient safety composite

Combined effect

A hospital with poor performance across all three programs:

• HRRP up to 3%
• HVBP up to 2% withhold
• HACRP 1%
• Combined potential: 6%+ payment reduction

For a hospital with $100 million base IPPS, this could be $6+ million annual revenue impact.

Strategic implications

Hospital quality programs must address all three simultaneously. Investments in care transitions (HRRP), patient safety (HVBP, HACRP), patient experience (HVBP), and efficiency (HVBP MSPB) are interconnected.

MedPAC analyses of HRRP

Effectiveness research

MedPAC has analyzed HRRP effectiveness over the years. Findings include:

• Readmission rates have decreased nationally since HRRP implementation
• Decrease may reflect both real care improvement and shifts in admission patterns
• Mixed evidence on whether the decrease has translated to improved patient outcomes

Unintended consequences

MedPAC and other researchers have identified concerns:

Observation status increases

Hospitals may admit some borderline cases as observation status rather than inpatient to avoid future readmission counting. Observation status:

• Outpatient (Part B)
• Different patient experience
• Different financial implications for beneficiaries
• HRRP measures inpatient discharges, so observation does not trigger readmission risk

ED returns without admission

Hospitals may discharge from ED without admission when previously they might have admitted. Patient receives ED care but no admission counted.

Post-acute care substitution

Hospitals may discharge to home health, SNF, or other post-acute settings rather than discharge to home, hoping to avoid readmission.

Mortality concerns

Some research suggests possible mortality increases in heart failure patients. Research is contested. Hypothesis: hospitals may delay or avoid admissions to improve readmission metrics, with adverse mortality consequences.

Equity concerns

• Safety-net hospital concentration of penalties (largely addressed by Cures peer groups)
• Continued socioeconomic concerns
• Racial and ethnic disparities

Reform recommendations

MedPAC has recommended various HRRP modifications. Most have not been fully implemented. Section 15002 Cures Act peer groups represent the major reform.

AHA litigation and advocacy

AHA position

AHA has historically:

• Supported the principle of quality improvement
• Opposed specific HRRP elements deemed unfair to certain hospital types
• Advocated for socioeconomic adjustment (achieved through Cures peer groups)
• Participated in litigation on specific methodology issues

Litigation history

Various AHA and individual hospital lawsuits have addressed:

• Risk adjustment methodology
• Measure specifications
• Penalty calculation methodology
• Procedural issues

Most major HRRP statutory provisions have been upheld. CMS implementing rules have been adjusted through litigation in some cases.

Major Georgia hospitals and HRRP

Grady Memorial Hospital

• Atlanta safety-net hospital
• Highest dual eligible proportion in metro Atlanta
• Group 5 peer group (highest dual eligible)
• Historical penalty exposure reduced after Cures Act peer groups
• Active care transitions team
• Coordination with Grady-affiliated community health resources

Emory University Hospital

• Academic medical center
• Lower dual eligible proportion than Grady
• Likely Group 2-3 peer group
• Active quality improvement programs
• Care transitions infrastructure

Memorial Health Savannah

• HCA Healthcare-affiliated
• Coastal Georgia regional safety-net
• Moderate-to-high dual eligible proportion
• Likely Group 3-4 peer group
• Care transitions program

AU Medical Center

• Augusta academic medical center
• Moderate dual eligible proportion
• Combined IME, DSH, HRRP considerations
• Care transitions program

Phoebe Putney Memorial Hospital

• Rural southwest Georgia
• High dual eligible proportion
• Group 4-5 peer group
• Care transitions program coordinated with rural skilled nursing facilities

Atrium Health Floyd

• Northwest Georgia
• Moderate dual eligible proportion
• HRRP-subject hospital

Northeast Georgia Medical Center

• Northeast Georgia
• HRRP-subject

Wellstar facilities

• Multiple Atlanta-metro and Georgia hospitals
• Various peer groups depending on facility
• Wellstar system-wide quality programs

Piedmont facilities

• Multiple Atlanta-metro and Georgia hospitals
• Various peer groups
• Piedmont system-wide programs

Northside Hospital

• Atlanta-metro
• Various locations
• HRRP-subject

Children's Healthcare of Atlanta (CHOA)

• Children's hospital
• Pediatric population
• HRRP measures focused on adult conditions; CHOA application limited

Worked example 1: Grady Memorial Hospital HRRP

Grady's profile suggests:

• Dual eligible proportion >30% (Group 5 peer group)
• High readmission rates absolute
• Risk-adjusted comparison to peer group median (other high-dual-eligible safety-net hospitals)
• Penalty likely modest given peer group framework
• Pre-Cures Act peer groups: substantial penalty risk
• Post-Cures Act: penalty risk substantially reduced

Numerical illustration

• Grady base IPPS: ~$150M annually
• Hypothetical HRRP penalty: 0.5% to 1.5% of base IPPS (varies year)
• Penalty: $750K to $2.25M annually
• Significant but manageable

Care transitions investment

• Multi-disciplinary care transitions team
• Coordination with Grady-affiliated primary care
• Coordination with community resources
• Pharmacist medication reconciliation
• Social work support

Worked example 2: Peer group analysis under Cures

Hypothetical Hospital A (dual eligible 35%, Group 5):

• ERR for HF: 1.06
• Group 5 median ERR for HF: 1.03
• Hospital A's relative performance: 0.03 above median (penalty)

Hypothetical Hospital B (dual eligible 12%, Group 2):

• ERR for HF: 1.06
• Group 2 median ERR for HF: 1.00
• Hospital B's relative performance: 0.06 above median (larger penalty)

Both hospitals have same absolute ERR (1.06), but the peer group methodology gives Hospital A relatively lower penalty because the peer group it competes against also has high absolute ERR.

Pre-Cures methodology would have compared both hospitals to national average:

• Both 1.06 vs national average ~1.0
• Identical large penalty for both
• Hospital A (safety-net) faced disproportionate penalty

Worked example 3: Phoebe Putney rural HRRP

• Rural southwest Georgia
• High dual eligible proportion (Group 4-5)
• Substantial Medicaid and uninsured share
• Local primary care availability variable
• Rural skilled nursing facility coordination challenging

Care transitions challenges

• Rural workforce constraints
• Patient travel to follow-up appointments
• Home health coverage variations
• Health information exchange limitations

Investment strategy

• Care coordinator program
• Coordination with rural SNFs
• Telehealth follow-up
• Pharmacist medication review

Penalty profile

• Group 4-5 peer group comparison
• Penalty risk moderate
• Investments to maintain peer group ranking

Worked example 4: AU Medical Center academic HRRP

• Academic medical center
• Complex case mix (higher acuity)
• Moderate dual eligible proportion
• Likely Group 3 peer group
• Risk adjustment methodology relevant
• Care transitions program

Six condition-specific performance

• AMI: academic patients often higher acuity
• HF: established academic protocols
• PN: standard
• COPD: rural referral patterns
• THA/TKA: orthopedic program
• CABG: cardiac surgery program

Combined considerations

• HRRP + HVBP + HACRP combined
• IME and DSH base payments at risk
• Quality investment strategy

Worked example 5: Memorial Savannah HCA HRRP

• HCA Healthcare-affiliated
• Coastal Georgia regional center
• Moderate-to-high dual eligible
• Group 3-4 peer group
• HCA system-wide quality programs

Care transitions

• HCA centralized care transitions framework
• Local Savannah implementation
• Coordination with Savannah-area SNFs and home health
• Coastal Georgia geography (drive time considerations)

Worked example 6: Care transitions program

Imagine a comprehensive care transitions program at a Georgia hospital:

Multi-disciplinary team

• Care coordinator nurse (RN, often BSN)
• Pharmacist medication reconciliation specialist
• Social worker (community resources, social determinants)
• Patient education specialist
• Discharge planning nurse

Workflow

Admission: identify high-risk patients (using validated risk score like LACE+, HOSPITAL, or 8P) During admission: education on diagnosis and self-management Pre-discharge: medication reconciliation, follow-up appointment scheduled, after-hospital care plan Discharge: care plan handoff to patient, family, primary care Post-discharge day 1-3: phone call from care coordinator Post-discharge day 7-14: follow-up appointment with primary care or specialist Post-discharge day 30: program completion or extension

Investment

• Team of 5-10 FTEs for medium-sized hospital
• Annual cost: $500K-1.5M
• Expected return: reduced readmissions, reduced HRRP penalty, improved patient outcomes

Evidence base

• Strong evidence for care transitions effectiveness
• ROI calculation: penalty savings vs program cost
• Patient outcomes beyond financial: improved health, satisfaction

Common HRRP compliance and quality improvement issues

Error 1: Risk adjustment not adequate for socioeconomic status Pre-Cures Act, this was the major concern. Section 15002 Cures Act peer groups largely addressed.

Error 2: ICD coding affecting comorbidity capture Risk adjustment depends on ICD coding. Incomplete coding can lead to insufficient risk adjustment.

Error 3: Observation status workarounds Some hospitals shift to observation status to avoid future readmission counting. Inappropriate observation use is itself problematic.

Error 4: ED return without admission Patient may return to ED multiple times without admission. Does not count for HRRP but represents quality and patient experience concern.

Error 5: Care transitions program inconsistency Programs may not be applied to all eligible patients. Inconsistent implementation reduces effectiveness.

Error 6: Medication reconciliation errors Medication reconciliation at admission and discharge is critical. Errors are common cause of readmissions.

Error 7: Follow-up appointment access If primary care or specialty appointment is not available within 7-14 days, follow-up planning fails.

Error 8: Social determinants of health Patients with food insecurity, housing instability, transportation barriers, or other social factors have higher readmission risk. Programs must address these.

Error 9: Health literacy Patient education must match patient health literacy. Verbal teach-back is essential.

Error 10: Skilled nursing facility coordination Discharge to SNF requires coordination. Errors in handoff cause SNF-to-hospital transfers.

Error 11: Home health agency coordination Discharge to home health requires coordination with the HHA.

Error 12: Multiple chronic condition complexity Patients with multiple chronic conditions need integrated care planning.

Error 13: Mental health and substance use Mental health and substance use comorbidities are major readmission risk factors. Often inadequately addressed.

Error 14: Combined HRRP/HVBP/HACRP integration Hospitals must address multiple quality programs in integrated way. Silos reduce effectiveness.

HRRP, beneficiary access, and care quality

The HRRP creates financial incentive for hospitals to improve care transitions, discharge planning, and post-discharge follow-up. The ultimate goal is improved beneficiary outcomes through reduced unplanned readmissions.

Beneficiary perspective

For Medicare beneficiaries, HRRP creates pressure that should result in:

• Better discharge planning
• Better medication reconciliation
• Earlier follow-up appointments
• Phone calls after discharge
• Coordination with primary care
• Coordination with skilled nursing and home health

Beneficiary advocacy

Beneficiary advocacy organizations participate in HRRP debate from access and quality perspective:

• Center for Medicare Advocacy
• Medicare Rights Center
• National Council on Aging
• AARP

Implications for vulnerable beneficiaries

Section 15002 Cures Act peer groups responded to concerns that vulnerable beneficiaries at safety-net hospitals were harmed by HRRP through reduced hospital resources and potential adverse practices. The reform was substantial improvement but continuing attention to safety-net hospital quality and resources remains important.

Beneficiary education

Care Compare website helps beneficiaries make informed hospital choice decisions. Hospital readmission rates publicly available.

Recent CMS HRRP rulemaking

Annual IPPS final rule

Each year's IPPS final rule addresses HRRP including:

• Annual HRRP results
• Methodology refinements
• Measure updates
• Peer group methodology adjustments

COVID-19 impacts

The COVID-19 pandemic affected HRRP in various ways:

• Measurement period adjustments during pandemic peak
• Risk adjustment for COVID-19
• Care delivery pattern shifts
• Continuing analysis

Future direction

• Continued refinement of peer group methodology
• Potential additional measures
• Continued attention to social determinants of health
• Integration with broader value-based payment

Care transitions and post-acute care

SNF coordination

Skilled nursing facilities are major receivers of hospital discharges. SNF-to-hospital readmissions are substantial component of HRRP. Coordination strategies:

• Standardized handoff communication
• INTERACT-style early identification at SNF
• Pre-discharge SNF acceptance verification
• Post-discharge follow-up with SNF

Home Health Agency coordination

Home health agencies often receive hospital discharges. HHA-to-hospital readmissions occur. Coordination strategies:

• Start of care visit within 24-48 hours of discharge
• Medication reconciliation
• Education and assessment
• Communication with primary care

Hospice transition

For appropriate end-of-life patients, transition to hospice can prevent unnecessary readmissions. Hospice election by Medicare beneficiary requires:

• Terminal illness diagnosis with prognosis ≤6 months
• Voluntary election of hospice benefit
• Section 1812 and Section 1813 of SSA

Long-term care transitions

For patients requiring long-term care, transition planning to nursing facility or other long-term care setting is essential.

Working with Brevy and Georgia resources

Brevy publishes regularly updated guides at brevy.com on Medicare, Medicaid, hospital quality, and related topics. We do not provide quality improvement consulting, legal advice, or hospital operations advice. We provide research-grade content explaining the framework so that Georgia hospital teams, administrators, and Medicare beneficiaries can understand how Medicare quality-based payment programs work.

For hospital provider HRRP questions, contact Palmetto GBA at 1-866-238-9650, engage Georgia Medical Care Foundation for QIN-QIO support, or work with quality improvement consulting firms. For Medicare beneficiary questions about hospital quality, contact Medicare at 1-800-MEDICARE, GeorgiaCares SHIP at 1-866-552-4464, or use Care Compare at medicare.gov/care-compare.

HRRP measure technical specifications

The Yale CORE measure specifications are extraordinarily detailed and run to hundreds of pages per measure. The technical complexity is one reason HRRP penalty calculation is opaque to many stakeholders, including hospital clinical staff who may not understand precisely how their patient population produces a specific ERR.

Index admission definition

Each measure begins by defining the population of index admissions. The general framework:

• Medicare fee-for-service beneficiaries (Part A enrollment)
• Age 65 or older for most measures
• Discharged alive from an acute care hospital subject to IPPS
• Specific principal diagnosis (e.g., AMI ICD-10 codes for AMI measure)
• Not transferred to another acute care hospital
• Not enrolled in hospice during admission
• Not against medical advice (AMA) discharge

Index admission exclusions

Specific exclusions per measure further narrow the population:

• Hospital discharges within 30 days before index admission (to avoid double-counting)
• Specific clinical exclusions (e.g., for AMI: same-day transfers, certain comorbidities)
• Hospital-acquired conditions that complicate measurement
• Patients without continuous Medicare Part A enrollment in baseline period
• Patients with key data missing from claims

Outcome definition

The 30-day all-cause readmission outcome is:

• Any unplanned readmission to any acute care hospital
• Within 30 days of discharge from index admission
• For any cause (all-cause)
• Excluding planned readmissions per CMS planned readmission algorithm

Planned readmission algorithm

CMS developed and maintains an algorithm identifying readmissions that are planned and therefore excluded from HRRP measurement. Planned readmissions include:

• Scheduled procedures (e.g., elective hip replacement)
• Chemotherapy for cancer
• Transplantation
• Maintenance procedures (e.g., dialysis access)
• Rehabilitation
• Specific diagnosis groups identified as typically planned

The algorithm produces conservative identification of planned readmissions to avoid inappropriately excluding readmissions that should count.

Risk factor selection

Risk factors included in the hierarchical logistic regression models were selected based on:

• Clinical relevance to the outcome
• Statistical association with readmission
• Reliability of measurement in administrative claims
• Avoiding gaming or perverse incentives

Specific risk factors vary by measure but typically include age, sex, comorbid conditions captured in 12-month look-back claims, and severity indicators. The Yale CORE measure specifications document exactly which factors enter each measure's risk-adjustment model.

Hierarchical model details

The hierarchical logistic regression model has two levels:

• Patient level: individual patient characteristics predict probability of readmission
• Hospital level: hospital-specific random effect captures unexplained variation across hospitals

The hospital random effect represents what the model attributes to the hospital after accounting for patient mix. This is the basis for the RSRR calculation. Hospitals with random effects significantly above zero are penalized; hospitals with random effects significantly below zero are recognized as performing better than expected.

Bayesian shrinkage

The hierarchical model produces shrinkage that pulls small hospital estimates toward the national average. This addresses statistical concern that small hospitals would otherwise have extreme estimates based on few cases. Shrinkage:

• Reduces variability for low-volume hospitals
• Increases precision of estimates
• Reduces extreme values
• Effectively provides "borrow strength" across hospitals

The result is that very small hospitals are unlikely to be assessed as either far above or far below average, even if their unadjusted rates would suggest extreme performance.

Public reporting timelines

The HRRP timeline involves:

• Measurement period: three years
• Data collection: claims submitted and processed through Medicare
• Measure calculation: typically 9-12 months after end of measurement period
• Public reporting on Care Compare: shortly before fiscal year of penalty application
• Penalty application: October 1 fiscal year start

The lag between care delivery and penalty application is approximately 1.5-2 years. This means quality improvements implemented today will not affect penalties for two to three years.

Hospital-Specific Report

CMS produces a Hospital-Specific Report (HSR) for each hospital subject to HRRP. The HSR includes:

• Hospital-specific results for each measure
• Index admission counts
• Readmission counts
• Calculated rates and ERRs
• Peer group assignment
• Penalty calculation
• Comparison to peer group

The HSR is provided to hospitals during a preview period before public reporting. Hospitals can review for technical errors during the preview period.

Preview period and corrections

The preview period is approximately 30 days. During the preview period, hospitals can:

• Review HSR for data accuracy
• Identify claim coding errors
• Verify index admission and readmission counts
• Submit corrections through specified processes
• Submit appeals on limited grounds

Most preview period corrections involve clear coding errors or claim processing issues. Substantive disagreement with methodology or risk adjustment cannot be resolved through preview period correction.

Worked example 7: Wellstar Kennestone HRRP scenario

Wellstar Kennestone Hospital in Marietta is a major Wellstar Health System hospital with significant Medicare volume. Hypothetical illustration:

• Index admissions across six measures: approximately 5,000 over three-year period
• Distribution: HF ~30%, PN ~25%, AMI ~15%, COPD ~15%, THA/TKA ~10%, CABG ~5%
• Observed readmission rates within typical range for community teaching hospitals
• ERR calculation by measure shows three measures with ERR slightly above 1.0
• Aggregate Payments for Excess Readmissions calculation
• Payment Adjustment Factor of 0.4 percent
• Annual reduction approximately $1.2 million on $300 million Medicare IPPS base

Wellstar Kennestone's response includes:

• System-wide care transitions program
• Discharge planning standardization
• Medication reconciliation protocols
• Post-discharge phone calls within 72 hours
• Coordination with Wellstar primary care offices
• Coordination with skilled nursing facilities
• Home health agency partnerships

The Wellstar system approach leverages integrated delivery system advantages, including shared electronic health record across hospitals, primary care, urgent care, and ambulatory specialty, supporting continuity that reduces readmissions.

Worked example 8: Northeast Georgia Medical Center HRRP scenario

Northeast Georgia Medical Center (NGMC) in Gainesville is the major hospital for northeast Georgia, serving a regional population including parts of the southern Appalachian region. Hypothetical illustration:

• Index admissions: approximately 4,200 over three-year period
• HF measure represents largest share given chronic disease burden in service area
• Patient population includes substantial rural and lower-income beneficiaries
• ERR for HF and PN slightly above 1.0
• Peer group assignment in middle dual eligible band
• Payment Adjustment Factor of 0.5 percent
• Annual reduction approximately $850,000 on $170 million Medicare IPPS base

NGMC response includes:

• Regional care coordination program
• Telemedicine for post-discharge follow-up given large service area
• Partnership with regional primary care
• Coordination with regional skilled nursing facilities
• Patient education materials in multiple languages reflecting community demographics
• Community health worker integration

The NGMC case illustrates how regional and rural community hospitals approach HRRP differently than urban academic centers, with particular attention to geographic distance to follow-up care and community resources.

Worked example 9: rural Georgia critical access hospital HRRP exclusion

Several rural Georgia hospitals are designated Critical Access Hospitals and therefore excluded from HRRP. Examples include various small rural hospitals across south and middle Georgia. CAH exclusion means:

• No HRRP measure calculation
• No HRRP penalty
• Continued cost-based reimbursement at 101 percent reasonable cost
• No quality-based payment adjustment under HRRP

CAH status provides protection from HRRP penalties but does not exclude rural hospitals from quality improvement attention. CAHs participate voluntarily in quality measurement, including Hospital Compare reporting, even without HRRP financial consequence. CAHs work with GMCF QIN-QIO on quality improvement and care transitions. The Medicare Beneficiary Quality Improvement Project (MBQIP) is a specific CAH quality improvement program.

For rural Georgia communities, CAH exclusion preserves hospital viability while continuing to support quality improvement through technical assistance rather than financial penalty.

Worked example 10: Piedmont Healthcare system-level HRRP coordination

Piedmont Healthcare operates multiple hospitals across Georgia, including Piedmont Atlanta, Piedmont Henry, Piedmont Newnan, Piedmont Fayette, Piedmont Mountainside, Piedmont Athens Regional, Piedmont Macon, Piedmont Columbus Midtown, Piedmont Columbus Northside, and Piedmont Cartersville. Each hospital is subject to HRRP individually.

System-level approach includes:

• Centralized quality improvement infrastructure
• Standardized care transitions program across hospitals
• Shared electronic health record (Piedmont uses Epic) supporting continuity
• Coordinated discharge planning standards
• System-wide medication reconciliation protocols
• Coordinated post-discharge follow-up
• Coordinated primary care follow-up
• Coordination with Piedmont Clinic for ambulatory follow-up
• Coordinated relationships with skilled nursing facilities and home health agencies

Each Piedmont hospital reports HRRP results individually, but system-level coordination supports quality improvement across the system. The Piedmont approach illustrates how multi-hospital integrated systems leverage scale and integration to address HRRP while maintaining hospital-specific accountability.

Hospital quality improvement infrastructure

Effective HRRP response requires substantial quality improvement infrastructure within the hospital.

Quality and patient safety department

Most hospitals subject to HRRP maintain dedicated quality and patient safety department with:

• Chief Quality Officer or equivalent senior leader
• Quality improvement specialists
• Patient safety officers
• Data analysts
• Clinical informaticists

The department coordinates HRRP response across clinical and operational departments.

Care management and discharge planning

Care management is the operational front line for readmission reduction. Hospital care management includes:

• Case managers (RN typically)
• Social workers
• Discharge planning specialists
• Transition coaches in some programs
• Pharmacy support

Case managers assess readmission risk, coordinate discharge planning, facilitate post-discharge service arrangements, and communicate with patients and families.

Physician leadership

Physician leadership engagement is essential for clinical practice change that reduces readmissions. Physician leaders include:

• Hospitalist medical directors
• Service line medical directors (e.g., cardiology for HF, pulmonology for COPD)
• Chief Medical Officer
• Department chairs

Physician engagement drives clinical pathway development, attending physician practice patterns, and physician-to-physician handoff with primary care and post-acute providers.

Information technology infrastructure

HRRP response requires substantial information technology including:

• Electronic health record with discharge planning workflows
• Risk stratification tools (e.g., LACE score)
• Medication reconciliation tools
• Patient education modules
• Patient portal for post-discharge engagement
• Population health management platform
• Real-time alerts for readmissions
• Data analytics for HRRP performance

Many hospitals use commercial readmission prediction tools (e.g., Epic readmission risk score, Cerner readmission risk model, or third-party predictive analytics) integrated with EHR.

Data analytics

HRRP performance analysis requires data analytics capabilities:

• Hospital-level HRRP performance trending
• Service line analysis
• Patient cohort analysis
• Care transition effectiveness analysis
• Predictive modeling
• Comparative benchmarking
• Root cause analysis of readmissions

Hospitals invest in business intelligence and data analytics teams to support quality improvement decision-making.

Community partnerships

Effective readmission reduction extends beyond hospital walls. Community partnerships include:

• Primary care provider relationships
• Skilled nursing facility partnerships
• Home health agency partnerships
• Community paramedicine programs
• Community health worker programs
• Community-based organization partnerships
• Faith-based and community organization engagement
• Transportation partnerships

The most effective readmission reduction programs view the hospital as one component of a community health system rather than the sole locus of care.

Social determinants of health and HRRP

The relationship between social determinants of health (SDOH) and readmission rates is well-documented in the research literature. Beneficiaries with adverse social determinants experience higher readmission risk regardless of clinical quality of hospital care.

Documented SDOH effects on readmissions

Research identifies SDOH factors associated with higher readmission risk including:

• Low income
• Low educational attainment
• Limited English proficiency
• Housing instability and homelessness
• Food insecurity
• Transportation barriers
• Social isolation
• Limited health literacy
• Mental health and substance use disorders

These factors persist after discharge and affect ability to obtain follow-up care, medications, food, and stable housing essential for recovery.

Hospital SDOH screening

Many Georgia hospitals now conduct routine SDOH screening including:

• Food security questions
• Housing stability questions
• Transportation access questions
• Financial strain questions
• Social support questions
• Mental health and substance use screening

SDOH screening identifies patients with high-risk profiles requiring enhanced discharge planning and community-based support.

Hospital SDOH interventions

Hospital interventions addressing SDOH may include:

• Discharge medication delivery to home
• Transportation arrangement for follow-up appointments
• Connection to food assistance programs (SNAP, Meals on Wheels, food banks)
• Housing instability case management
• Behavioral health connection
• Social work involvement
• Community health worker engagement

These interventions are not directly captured in HRRP measurement but indirectly support readmission reduction.

CMS attention to SDOH

CMS has increasingly recognized SDOH in quality measurement:

• Section 15002 Cures Act peer groups indirectly capture SDOH through dual eligible proportion
• CMS Health Equity Index in HVBP incorporates dual eligible patient performance
• Future HRRP may include direct SDOH adjustment
• CMS Office of Minority Health publishes equity-focused analyses

The trajectory is toward more explicit SDOH consideration in quality programs, though direct SDOH risk adjustment in HRRP has not been implemented.

HRRP in the context of broader healthcare reform

HRRP is one component of the broader healthcare reform under the ACA and subsequent legislation. Related programs include:

Hospital Value-Based Purchasing (HVBP) within ACA reform

Section 1886(o) authorizes HVBP, which adjusts IPPS payments based on:

• Clinical care domain
• Person and Community Engagement domain (formerly Patient Experience)
• Safety domain
• Efficiency and Cost Reduction domain
• Health Equity Adjustment (added 2024)

HVBP redistributes 2 percent of IPPS payments from below-average performers to above-average performers, with net effect dependent on performance score relative to peers.

Hospital-Acquired Condition Reduction Program (HACRP) within ACA reform

Section 1886(p) authorizes HACRP, which reduces IPPS payments by 1 percent for hospitals in the worst-performing quartile on hospital-acquired conditions including:

• Healthcare-associated infections (CAUTI, CLABSI, SSI, MRSA, C. diff)
• PSI-90 patient safety indicators

Medicare Promoting Interoperability Program

Section 1886(n) authorizes Promoting Interoperability (formerly Meaningful Use), which adjusts IPPS payments based on EHR meaningful use.

Medicare Spending Per Beneficiary

A measure within HVBP, MSPB compares hospital-attributed Medicare spending per beneficiary to national average, creating incentive for efficient care delivery.

Accountable Care Organizations

Section 3022 of ACA established Medicare Shared Savings Program ACOs, which create population-level accountability for cost and quality. Georgia ACOs include various physician groups and integrated systems.

Bundled Payment Programs

Bundled Payments for Care Improvement (BPCI) and BPCI Advanced create episode-level payment for various procedures and conditions. These programs share readmission reduction objective with HRRP.

Patient-Driven Payment Model

PDPM for SNF and PDGM for home health adjust post-acute payment, indirectly affecting post-acute partner incentives for hospital coordination.

The combined effect of these reform programs is to shift hospital payment from pure volume-based fee-for-service toward value-based payment integrating quality, cost, and outcomes.

HRRP enforcement and dispute resolution

While HRRP penalties are largely formulaic based on measure calculations, certain dispute and review mechanisms exist.

Preview period review

As described above, hospitals review HSR during preview period and identify technical errors.

Limited reconsideration

CMS allows reconsideration on limited grounds, primarily:

• Clear data errors
• Calculation errors
• Eligibility issues (e.g., hospital status as CAH or excluded)
• Specific methodology application errors

No substantive appeal of methodology

Hospitals cannot appeal the underlying measure methodology, risk-adjustment models, or peer group methodology through individual review. These are matters of CMS rulemaking subject to notice-and-comment rulemaking and potential judicial review of rulemaking.

Judicial review of rulemaking

HRRP rules and methodology can be challenged through judicial review of final rulemaking. AHA, AAMC, and individual hospital systems have participated in various litigation challenges to specific HRRP methodology decisions over the years.

Provider Reimbursement Review Board

The PRRB has limited HRRP jurisdiction. Most HRRP disputes do not proceed through PRRB but rather through the limited reconsideration process and through judicial review of rulemaking.

Hospital strategic considerations

Hospital leadership considers HRRP in broader strategic context.

Quality reputation

Beyond direct financial penalty, HRRP performance affects:

• Care Compare public reporting
• Hospital reputation
• Patient choice
• Referral patterns
• Physician recruitment
• Payor contracting
• Bond ratings
• Community standing

For Georgia hospitals competing in major metropolitan markets like Atlanta, quality reputation is a significant strategic consideration.

Investment in care transitions

Investment in care transitions programs has demonstrated return on investment for many hospitals through reduced HRRP penalties and improved performance on related quality programs. ROI analysis typically considers:

• HRRP penalty reduction
• HVBP performance improvement
• HACRP performance
• Direct cost of preventable readmissions
• Indirect quality reputation benefits
• Community health benefit

Risk-bearing arrangements

Hospitals in risk-bearing arrangements (ACOs, capitation, bundled payments, Medicare Advantage at-risk contracts) have additional financial incentive for readmission reduction beyond HRRP. Hospital strategy increasingly integrates HRRP response with broader value-based payment strategy.

Workforce considerations

Effective care transitions programs require workforce including case managers, social workers, transition coaches, and care navigators. Workforce investment is necessary for sustained HRRP performance improvement.

Technology investment

Hospital technology investment for HRRP includes EHR enhancements, predictive analytics, patient engagement platforms, and care coordination technology. These investments often serve multiple purposes beyond HRRP.

Research evidence on HRRP effectiveness

The research literature on HRRP effectiveness is extensive and continues to evolve. Key findings:

Readmission rates have declined

Multiple analyses show that 30-day readmission rates for the targeted HRRP conditions declined substantially since HRRP took effect. Whether this decline is attributable to HRRP versus broader quality improvement trends, ICD coding practice changes, or observation status substitution remains debated.

Spillover effects

Research finds spillover effects on non-HRRP conditions, suggesting hospitals improved overall discharge practices rather than only targeting measured conditions. Spillover effects support the view that HRRP produced genuine quality improvement.

Mortality concerns

Some studies raised concern about possible increase in 30-day mortality following discharge for HF patients in the post-HRRP era. The interpretation is contested. Some researchers argue HRRP created incentive against admission of high-risk patients or for earlier discharge that contributed to mortality. Other researchers find no causal relationship and attribute observed mortality patterns to changes in patient population or coding.

Observation status increases

Hospital observation stay use increased substantially in the HRRP era. Observation stays are not counted as admissions for HRRP measurement, creating potential incentive for observation status that may not always serve patient interests, particularly given Medicare beneficiary cost-sharing implications.

Equity concerns in the research literature

Safety-net hospitals experienced disproportionate HRRP penalties before Section 15002 Cures Act peer group reform. Post-reform analyses suggest peer group methodology substantially reduced equity concerns but did not eliminate them.

Continuing research

MedPAC, CMS, academic researchers, and policy organizations continue to research HRRP effects. The Yale CORE methodology continues to evolve, and CMS continues to refine the program through annual rulemaking.

International comparison

The United States is not alone in implementing readmission-based hospital payment programs. Various OECD countries have implemented similar programs:

• England: NHS readmission penalties
• Germany: readmission tracking in DRG system
• Various jurisdictions in Canada and Australia

International comparison provides limited but useful perspective on HRRP design and effects.

HRRP and the future of value-based hospital payment

HRRP has been one of the most consequential and most studied of CMS value-based payment programs. The combined experience of HRRP, HVBP, HACRP, and other programs informs ongoing CMS strategy for value-based payment. The future direction likely includes:

• Continued refinement of measure methodology
• Greater attention to social determinants of health
• Greater attention to health equity
• Potential consolidation of multiple programs
• Integration with broader value-based payment

For Georgia hospitals, the trajectory means continued financial and operational attention to HRRP and related quality programs is essential to long-term financial health under Medicare.

Disclaimers

This article is for educational purposes only and does not constitute legal, financial, quality improvement, audit, compliance, or medical advice. HRRP rules are subject to change through CMS rulemaking, congressional action, and ongoing administrative guidance. The information in this article reflects rules in effect as of May 2026. Always verify current HRRP rules at cms.gov and through current Yale CORE measure specifications before making decisions.

Brevy is not affiliated with CMS, Yale CORE, HHS, GMCF, Palmetto GBA, MedPAC, AHA, or any hospital. Brevy is an eldercare research and information company. We accept no compensation from healthcare providers, hospitals, insurance carriers, audit firms, consulting firms, or other parties.

Information about Georgia hospitals reflects publicly available information as of the publication date. Specific HRRP performance estimates and peer group assignments are illustrative; actual values vary by year and depend on specific calculation factors. Verify current Care Compare data and IPPS final rule data before relying on it.

Learn More

• Georgia Medicare Hospital Value-Based Purchasing (HVBP)
• Georgia Medicare Hospital-Acquired Condition Reduction Program (HACRP)
• Georgia Medicare Hospital Inpatient Benefit
• Georgia Medicare Quality Payment Program (QPP)
• Georgia Medicare Cost Report
• Georgia Dual Eligibles in Medicaid and Medicare

Find personalized help understanding how Medicare hospital quality programs affect care in Georgia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.