The Hospital Readmissions Reduction Program (HRRP) in the Patient Protection and Affordable Care Act of 2010 (ACA) will reduce Medicare payments to "applicable hospitals" that have an excessive readmission rate for the "applicable conditions." This issue of Legal Notes outlines the framework of the HRRP final legislative rule. The brief discusses the implications for Aligning Forces for Quality (AF4Q) Alliances that are uniquely positioned to work with hospitals to reduce potentially preventable readmissions and provide meaningful information to consumers and patients concerning hospital readmissions. Issues to consider include:

• Control over Readmissions: Monitor hospitals' abilities to control readmissions.
• Risk-adjustment Readmission Measure: Monitor HRRP's impact on hospitals that predominately serve racial minorities or persons of low socioeconomic status and report any adverse results to CMS.
• Applicable Hospital and Payment Calculation: Communicate the complex cost and efficacy considerations posed by the HRRP.
• Reducing Readmissions: Provide information and practical recommendations for reducing readmissions. Alliances can also open lines of communication so hospitals can learn from each other's successes and failures.