State-by-State Hospital Readmission Rates and CMS Penalty Assessment
Data Source: CMS Hospital Readmissions Reduction Program (HRRP) public data. State-level aggregations of hospital performance metrics and Medicare penalty assessments. Data represents national hospital benchmarking for readmission quality measures.
This geographic analysis examines hospital readmission rates and CMS penalties across all 50 US states plus DC. The analysis reveals significant regional variation in readmission performance, with certain states consistently showing elevated rates that drive CMS penalty exposure.
The Southeast and Appalachian regions show the highest concentration of readmission risk. Louisiana (17.8%), West Virginia (17.6%), and Mississippi (17.1%) lead the nation in readmission rates, collectively representing $18.1M in estimated CMS penalties.
| Rank | State | Avg Readmission Rate | Hospital Count | Avg Penalty % | Est. Total Penalties |
|---|---|---|---|---|---|
| 1 | Louisiana | 17.8% | 109 | 1.94% | $9,333,648 |
| 2 | West Virginia | 17.6% | 55 | 1.88% | $3,411,907 |
| 3 | Mississippi | 17.1% | 83 | 1.85% | $5,312,423 |
| 4 | Oklahoma | 16.8% | 112 | 1.68% | $4,469,212 |
| 5 | Kentucky | 16.1% | 96 | 2.05% | $9,231,976 |
| 6 | Alabama | 16.0% | 98 | 2.11% | $9,437,750 |
| 7 | Maryland | 16.0% | 47 | 1.70% | $2,726,538 |
| 8 | Missouri | 16.0% | 113 | 1.46% | $4,391,642 |
| 9 | Tennessee | 16.0% | 116 | 1.12% | $3,452,958 |
| 10 | New York | 15.9% | 183 | 1.69% | $9,471,439 |
| Rank | State | Avg Readmission Rate | Hospital Count | Avg Penalty % |
|---|---|---|---|---|
| 1 | Hawaii | 11.8% | 14 | 0.42% |
| 2 | Idaho | 12.4% | 23 | 0.68% |
| 3 | Utah | 12.7% | 41 | 0.81% |
| 4 | Oregon | 13.1% | 58 | 1.02% |
| 5 | Washington | 13.3% | 87 | 1.15% |
States: Louisiana, Mississippi, Alabama, West Virginia, Kentucky, Tennessee
Characteristics:
Opportunity: Targeted regional quality improvement collaboratives could yield significant penalty reduction.
States: Hawaii, Idaho, Utah, Oregon, Washington
Characteristics:
Best Practices: Study transitional care programs and care coordination models from these states.
The Hospital Readmissions Reduction Program (HRRP) reduces Medicare payments to hospitals with excess readmissions. Penalties can reach up to 3% of total Medicare reimbursements.
| Penalty Range | Hospital Count | % of Hospitals | Avg Readmission Rate |
|---|---|---|---|
| No Penalty (0%) | 876 | 18.7% | 12.1% |
| Low (0.01-1.0%) | 1,453 | 31.0% | 13.8% |
| Moderate (1.0-2.0%) | 1,687 | 35.9% | 15.2% |
| High (2.0-3.0%) | 676 | 14.4% | 17.4% |
The 676 hospitals in the high-penalty tier (2-3%) face an estimated $47M in annual Medicare payment reductions. For a typical 300-bed hospital, this represents $70K-$150K in lost revenue annually.
Identify best-performing hospitals in your state and region. Study their care coordination models, discharge processes, and community partnerships.
HRRP penalizes readmissions for: Heart Failure, AMI, Pneumonia, COPD, Hip/Knee Replacement, CABG. Focus quality initiatives on these diagnoses.
Join or establish state/regional hospital collaboratives to share best practices and negotiate group purchasing for care management technology.
Implement standardized screening for transportation, housing, food insecurity, and health literacy at discharge to enable targeted support.