The Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program initiated a seismic shift in US hospitals' attitudes toward coordinating transitions of care.1 Effective October 2012, more than 2000 hospitals began losing money (national total of ~ $300 million the first year) to financial penalties for excess readmissions,2 and this penalty could triple for some hospitals by 2014 under provisions stipulated by §3025 of the Patient Protection and Affordable Care Act. This program aims to slow growth in hospital inpatient costs (a quarter of the more than half trillion dollars in annual Medicare expenditures) and increase the value of medical care delivered to its beneficiaries. Despite representing less than 0.1% of the overall CMS budget, these penalties for excess readmissions of patients discharged after hospitalizations for heart failure, acute myocardial infarction, or pneumonia are driving change across the United States.
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