Coming November 10: CMS-Aligned Update to Readmission (R) Flag Logic

We are updating the logic used to calculate the Readmission (“R”) flag for inpatient encounters to align with the CMS Hospital-wide Readmission (HWR) Measure methodology. This brings our approach in line with the industry standard used across hospitals and quality reporting frameworks.

Thus far, the “R” flag has identified inpatient readmissions based on a simple time-based rule (a new inpatient encounter from an emergency visit within 30 days of a previous one, excluding those within 36 hours).

With this update, the flag will now follow the CMS HWR logic, which:

• Defines eligible index admissions based on specialty and exclusion rules (e.g. excluding oncology, rehab, or mental health admissions).
• Differentiates planned vs. unplanned readmissions using CMS terminology mappings.
• Excludes same-day transfers and planned readmissions from the readmission count.
• Ensures only the first unplanned readmission within 30 days of an index admission is flagged.

This change improves accuracy by better distinguishing true unplanned readmissions from planned or related transfers.

After the change, you may notice fewer Lens Encounters flagged as “R” compared to before, as planned readmissions and transfers are now excluded.

• The flag itself (R) remains the same — only the underlying logic has been updated.
• This aligns readmission identification with CMS’s Hospital-wide Measure (HWR) standards.
• The TOC Lens Behavior remains the same - if the Lens Encounter has the Readmission flag set to ‘R’, the nonElectiveAdmission flag on the TOC Lens will be set.

The Encounter Lens documentation will be updated alongside the release on November 10.