US Senate - H.R. 3590 Patient Protection and Affordable Care Act

Sec. 2717. Ensuring quality of care. Requires the Secretary to develop guidelines for use by health insurers to report information on initiatives and programs that improve health outcomes through the use of care coordination and chronic disease management, prevent hospital readmissions and improve patient safety, and promote wellness and health.

Sec. 3025. Hospital readmissions reduction program. Beginning in FY2012, this provision would adjust payments for hospitals paid under the inpatient prospective payment system based on the dollar value of each hospital’s percentage of potentially preventable Medicare readmissions for the three conditions with risk adjusted readmission measures that are currently endorsed by the National Quality Forum (heart attack, heart failure, and pneumonia). Also, provides the Secretary authority to expand the policy to additional conditions in future years and directs the Secretary to calculate and make publicly available information on all patient hospital readmission rates for certain conditions.

Sec. 3503. Grants to implement medication management services in treatment of chronic disease. Creates a program to support medication management services by local health providers. Medication management services will help manage chronic disease, reduce medical errors, and improve patient adherence to therapies while reducing acute care costs and reducing hospital readmissions.

In the Manager’s Amendment:

Sec. 10309. Revisions to hospital readmissions reduction program. Makes a technical correction to the hospital readmissions reduction program.

Sec. 10335. Technical correction to hospital value-based purchasing (VBP) program. Clarifies that the hospital VBP program shall not include measures of hospital readmissions.

House - H.R. 3962 The Affordable Health Care for America Act

Sec. 1151. Reducing potßentially preventable hospital readmissions. Beginning in fiscal year 2012, adjusts payments for 1886(d) hospitals, critical access hospitals and hospitals paid under 1814(b)(3) based on the dollar value of each hospital’s percentage of potentially preventable Medicare readmissions for 3 conditions with risk adjusted readmission measures that are endorsed by the National Quality Forum. Directs the Secretary to expand the policy to additional conditions in future years and authorizes the Secretary to modify the adjustment based on a hospital’s performance in readmissions compared to a ranking of hospitals nationally. Provides assistance to certain hospitals for transitional care activities to address patient noncompliance issues that may result in high readmission rates. Creates an interim readmissions policy for post-acute providers beginning in FY 2012, and directs the Secretary to develop risk adjusted readmission rates for post-acute providers and implement a readmissions payment system for those providers similar to the hospital system on or after FY 2015. Directs the Secretary to submit a report to Congress no later than one year after date of enactment on how physicians can be incorporated into the readmissions policy. Directs the Secretary to monitor inappropriate changes in admission practices by hospitals and post-acute providers and authorizes the Secretary to penalize providers that are avoiding patients at risk of a readmission.