The Hospital Readmissions Reduction Program
Authorized under Section 3025 of the Affordable Care Act, HRRP requires CMS to reduce payments to acute care hospitals with excess readmissions. The program measures 30-day risk-standardized readmission rates for six specific conditions and compares each hospital's performance against a national baseline.
The maximum penalty is 3% of all Medicare inpatient payments — not just payments for the penalized conditions. A hospital receiving $20 million in annual Medicare inpatient payments faces up to $600,000 in potential penalties. In practice, the average penalty runs approximately $217,000 per affected hospital.
More than 2,500 hospitals are penalized in a typical HRRP program year. Vizier calculates your current risk-standardized readmission rates by condition and models your projected penalty before CMS publishes its annual determination.
LACE Score: Predicting Who Returns Within 30 Days
The LACE index (0–19 scale) predicts 30-day readmission and death after hospital discharge. Scores of 10 or higher indicate high risk. Vizier calculates LACE for every discharge automatically from your ADT and clinical data.
Length of Stay
Longer inpatient stays correlate with higher readmission risk. Vizier calculates the LACE L-score (1 point per day, capped at 7) for every discharge.
Acuity of Admission
Acute admissions via emergency department carry higher LACE scores than elective admissions. Acuity is captured at the point of admission.
Comorbidity of Patient
Charlson Comorbidity Index is used. Conditions including prior MI, CHF, diabetes with complications, renal disease, and malignancy add to the score.
Emergency Department Use
Number of ED visits in the 6 months prior to admission. Each visit adds points; 4+ visits in 6 months carries the maximum score.
What Happens After Discharge Drives Readmission Risk
Medication non-compliance is the leading driver of preventable readmissions — accounting for approximately 38% of avoidable returns. Patients who do not fill discharge prescriptions within 72 hours are significantly more likely to return within 30 days.
The 7-day follow-up benchmark: industry best practice requires scheduling a follow-up appointment within 72 hours of discharge and completing it within 7 days. Vizier tracks this compliance rate at the provider and unit level, flags patients who have not yet scheduled, and models the readmission rate impact of closing the gap.
The CMS 30-day readmission window covers any unplanned inpatient readmission within 30 days of discharge, regardless of diagnosis at readmission. Planned readmissions (per the CMS Planned Readmission Algorithm) are excluded from the measure calculation.
LACE+ vs HOSPITAL vs Epic Readmission Risk Score
Three readmission risk scores dominate clinical use. They were validated on different populations, use different inputs, and answer slightly different questions. Vizier supports all three and lets you choose by patient cohort — or run them in parallel for triangulation.
LACE+
UniversalLength of stay, Acuity (ED admit y/n), Charlson Comorbidity Index, ED visits in prior 6 months — plus age, sex, prior admissions, and alternative level of care days.
Derived and validated in Ontario; replicated across US, EU, and AU populations.
Default for any inpatient population — every input is reliably captured in any modern EHR or ADT feed.
Less discriminative for surgical-only populations; pair with a procedure-specific score (NSQIP) for elective surgery cohorts.
HOSPITAL
MedicalHemoglobin at discharge, oncology diagnosis, sodium at discharge, ICD procedures performed, index admission type, prior admissions in last year, length of stay.
Derived at Brigham and Women's; widely replicated in medical inpatient populations.
Medicine service lines where discharge hemoglobin and sodium are reliably drawn.
Underperforms for purely surgical or behavioral health discharges where discharge labs are not standard.
Epic Readmission Risk
EHR-nativeProprietary Epic model using flowsheet vitals, lab trends, medication changes, social history, prior utilization, and demographics.
Epic-validated against the customer's own population; performance varies by setting and configuration.
Epic shops that already trust the embedded score and want it surfaced alongside LACE+/HOSPITAL for cross-check.
Score logic is partially opaque; not portable across EHRs; not comparable across health systems without recalibration.
Vizier computes all three when the data supports them, then presents each patient at the highest assigned risk band across scores — the practical default, since a patient flagged by any score deserves attention, not just patients flagged by all three.
Identify Variation Before CMS Does
Readmission rates vary significantly by attending physician, discharge unit, and care team. Vizier surfaces provider-level readmission rates, stratified by condition and risk score, so performance improvement conversations are grounded in data — not anecdote.
Discharge Planning Gap Analysis
Identifies patients discharged without completed medication reconciliation, follow-up appointments, or patient education documentation.
Root Cause Attribution
Tags each readmission with primary cause: medication issue, follow-up failure, social determinants, disease progression, or surgical complication.
Condition-Specific Rate Trending
Track your risk-standardized readmission rate for each HRRP condition month over month, compared to national median and top-quartile benchmarks.
How readmission data gets into Vizier
Direct connectors to Epic, Cerner / Oracle Health, MEDITECH, and the inpatient EHRs that handle discharge. Or scheduled feed. Or upload.
Connect Vizier directly to your EHR via FHIR R4 or HL7 v2 and pull Encounter (with hospitalization element), Condition, Patient, DischargeDisposition resources for LACE / HOSPITAL scoring and 30-day readmission tracking on a schedule or on demand. Live for Epic, Cerner / Oracle Health, AthenaHealth, Allscripts / Veradigm, MEDITECH, SystmOne, EMIS, NextGen, eClinicalWorks. OAuth 2.0 / SMART on FHIR, read-only, BAA executed before any PHI flows.
Your existing reporting environment writes CSV to SFTP or secure cloud storage. Vizier picks it up. Most common path for organizations with internal data warehouses or restricted external API access.
When you need the answer this hour. Ad-hoc analysis, data outside your EHR (payer files, registry exports, survey data), or proof-of-value before IT approves a connector.
FAQ
Readmission Prevention Questions Health Systems Ask
Does Vizier score patients with LACE, HOSPITAL, or both?+
Both — automatically, at discharge, from EHR-pulled data. LACE is the default since every input is universally available in any inpatient EHR (length of stay, acute admission flag, Charlson comorbidity, prior ED visits). HOSPITAL is offered alongside for medical populations where the additional inputs (hemoglobin and sodium at discharge) are reliably captured. Customers can also layer SDOH risk on top of either score where SDOH screening data is available.
Which HRRP conditions does Vizier track?+
All six HRRP-targeted conditions: Acute Myocardial Infarction (AMI), Coronary Artery Bypass Graft (CABG), Chronic Obstructive Pulmonary Disease (COPD), Heart Failure (HF), Pneumonia (PN), and Total Hip / Knee Arthroplasty (THA/TKA). Vizier calculates Excess Readmission Ratio (ERR) for each condition and projects the aggregate penalty multiplier against your Medicare DRG payments.
How early can we see a readmission risk score for a current inpatient?+
From admission. Vizier scores patients as they progress through the stay — LACE updates with length-of-stay accumulation and emerging diagnoses, HOSPITAL updates when discharge labs land. By 24 hours before discharge, the score is settled and the discharge planning team can route high-risk patients to extended teach-back, scheduled 7-day follow-up, or pharmacy med rec.
Does Vizier track readmissions to other hospitals or only our own?+
Same-hospital readmissions are tracked automatically from your EHR data. Cross-hospital readmissions require a data source that captures them — typically a state HIE or all-payer claims database. Where available, Vizier ingests these feeds; where not, Vizier surfaces the same-hospital rate which is the rate CMS uses for HRRP calculation anyway.
How does discharge planning gap analytics work?+
Vizier joins discharge planning artifacts (medication reconciliation completion, scheduled follow-up appointment, patient education documentation, transportation plan) to subsequent readmission events. The view: of patients readmitted in the last 90 days, what fraction had a complete discharge plan addressing the readmission cause? When the answer is under 50%, the intervention is workflow, not predictive modeling.
What does Vizier cost to deploy for a hospital with 8,000 annual discharges?+
Health System tier at $1,497/month flat covers up to 25 users, one direct EHR connector, and all readmission analytics. Enterprise tier at $3,997/month adds multi-EHR connector breadth and dedicated CSM. Recovery typically pays back the cost in the first quarter — the average HRRP penalty in FY2024 was $217,000.
Calculate Your HRRP Penalty Exposure
Upload your discharge data and see your current 30-day readmission rates by condition, your projected HRRP penalty, and which patient segments represent the highest intervention opportunity.