Table 4.

Approximation of DRG Payments Attributable to Excess Readmissions for Hospitals with Reliable and Unreliable RSRRs for Each Condition, and the Total and Percent of DRG Payments Tied to Unreliable RSRRs

Condition	Average DRG Weight	Hospitals with Reliable RSRRs (R ≥ 0.70)			Hospitals with Unreliable RSRRs (R < 0.70)			DRG Payments for Excess Readmissions
		Total Admits	Sum of DRG Paymentsa	DRG Payments for Excess Readmitsb	Total Admits	Sum of DRG Paymentsa	DRG Payments for Excess Readmitsb	Total Payments	% Tied to Unreliable RSRRs
AMI	2.358	69,804	$984,323,017	$29,558,832	67,787	$955,880,814	$49,895,732	$79,454,564	63
CHF	1.340	128,080	$1,026,359,833	$31,468,163	177,839	$1,425,099,987	$73,177,899	$104,646,062	70
PN	1.518	155,853	$1,414,817,646	$67,288,716	74,806	$679,081,424	$47,237,616	$114,526,332	41
COPD	1.196	119,625	$855,591,892	$35,954,623	95,756	$684,874,042	$44,826,502	$80,781,125	55
THKA	2.173	217,909	$2,831,707,715	$396,677,618	0	$0	$0	$396,677,618	0
CABG	5.325	53,273	$1,696,447,001	$111,761,966	1,814	$57,765,751	$8,500,593	$120,262,559	7
Total	–	744,544	$8,809,247,104	$672,709,918	418,002	$3,802,702,018	$223,638,342	$896,348,260	25

If a hospital had an ERR less than or equal to one (i.e., no excess readmissions), they had no DRG payments for excess readmissions.

^aSum of DRG Payments = Total Admits*Average DRG Weight*Base Operating Cost ($5,980.17).

^bDRG Payments for Excess Readmits = Sum of DRG Payments*[Excess Readmission Ratio (ERR) − 1].