On October 1, 2012, the Centers for Medicare & Medicaid Services began penalizing hospitals for high readmission rates as part of the US Patient Protection and Affordable Care Act's Hospital Readmission Reduction Program (HRRP).1 Hospitals that have been designated high readmission outliers have had their Medicare payments reduced by 1% for adult patients discharged with congestive heart failure, pneumonia, and acute myocardial infarction. Penalties will increase to 3% by 2015, and other conditions will be added to the list for which those penalties apply.2 This focus on reducing 30-day readmission rates is part of a larger strategy to help control rising health care costs. While critics have complained that the HRRP is a blunt instrument that fails to account for distinguishing characteristics of hospitals and the patient populations that they serve,3 the Supreme Court's recent decision ensures that the Affordable Care Act's mandates will be implemented.4 To date, hospitals that care for children have not been targeted by the HRRP, but often policies that start in adult hospitals eventually migrate to hospitals that care for children. If that happens, then the study by Berry and colleagues5 in this issue of JAMA will take on substantial significance.
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