Vicky A. Mahn-DiNicola RN, MS, CPHQ Vice President, Solutions Strategy Midas+, Xerox Services

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Midas+™ DataVision and 3M Potentially Preventable Readmission Enhancements Plus a special overview of the Hospital Readmission Reduction Program. Vicky A. Mahn-DiNicola RN, MS, CPHQ Vice President, Solutions Strategy Midas+, Xerox Services. - PowerPoint PPT Presentation

Transcript of Vicky A. Mahn-DiNicola RN, MS, CPHQ Vice President, Solutions Strategy Midas+, Xerox Services

Understanding Emerging Complications and their Implications

Midas+ DataVision and 3M Potentially Preventable Readmission Enhancements Plus a special overview of the Hospital Readmission Reduction ProgramVicky A. Mahn-DiNicola RN, MS, CPHQVice President, Solutions StrategyMidas+, Xerox Services1Potentially Preventable Readmissions Added in DataVision Web Application in May!21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona2

Report Parameters Allow You to Run Reports for 15 or 30 Day Readmissions321st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona

Palliative care code v66.7 when principal is a nonevent Secondary are included in PPR methodology PPR grouper has a setting that will exclude palliative care if it is POA. However, this code is exempt from POA reporting. Due to the variations in coding v66.7, and the use of the POA flag with this code, it was determined that it would be best to include this population in PPR reporting.

CDB Mean PPR RateThe CDB mean PPR rate is determined by multiplying the number of the APR DRG encounters in each severity level by the PPR rate for that severity level. The sum for all four severity levels is divided by the total number of PPR At Risk cases (initial and only admissions) for the APR DRG (N=), and then multiplied by the mental health/age adjustment factors and then multiplied by 100 to state the result as a percentage.

Sum of (CDB encounters* PPR rate) for each subclass Mental Health/Age---------------------------------------------------- * Adjustment * 100Total PPR At Risk cases for the APR DRG in the CDB factors

3 Potentially Preventable Readmissions Added to APR DRG Service Line Profile21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona4

Readmissions Tab added to APR DRG Subclass Detail Report in May21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona5

More PPR Reports Coming in July

Adding Tab for Saved Readmissions 621st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona

APR DRG Encounter Level DataNow being provided to all DataVision clientsSeparate license with 3M not requiredData planted back on your server in May 2012Transitioning to monthly plant back in August so that data will be 2 months old instead of sixStandard Reports on server to drill down to patient and provider level potentially preventable data coming in August

21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona7

And it just keeps getting betterMore Cool Stuff Under Construction!PPRs to be added to Physician Reports in the DataVision Web Application in October 2012Potentially Preventable Complications to be added in January 2013 DataVision Web UpdatePPC Server based reports for patient drill down planned for May 201321st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona8

Benefits of 3M Potentially PreventableReadmissions & Complications Focuses attention on cases that you can affect through improved clinical and care management processesHelps you understand the needs of your key populationsTrended PPR & PPC performance more sensitive to performance improvement initiativesOptimally used with APR DRG LOS and Mortality findings to understand changing populations 921st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona

Training Webinars for APR DRG PPRs June 13, 2012 - 10:30 am Pacific TimeJune 15, 2012 - 8:30 am Pacific TimeJune 21, 2012 - 1:30 pm Pacific Time

Register on the Midas+ Clients Only Website21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona10

Hospital Readmissions Reduction ProgramBegins with October 1, 2012 discharges Payments to hospitals will be reduced for excess 30-day readmissions following an index discharge NQF #0505 Acute MI 30-day Risk Standardized ReadmissionNQF #0330 Heart Failure 30-day Risk Standardized ReadmissionNQF #0506 Pneumonia 30-day Risk Standardized Readmission Excludes patients with in-hospital death, without at least 30 days post-discharge enrollment in Medicare FFS, discharged AMA or under the age of 65. Only 1 readmission during 30 days following discharge from the initial hospitalization will count as a readmission for purposes of calculating adjustment factors

21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona1111CMS Readmission Risk Adjustment MethodologyPatient demographic factorsCo-morbid diagnoses and indicators of frailtyData source is from Medicare Part A and B claims (excluding Medicare Advantage) 12 months prior to and including the index admissionDischarges July 1, 2008 to June 30, 2011 will be used by CMS to calculate the excess readmission ratios used to determine payment in FY 2013Midas+ can NOT replicate this measureMethodology is available at: http://qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier4&cid=1219069855841.

21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona1212Review of Proposed IPPS Rule CMS-1588-PPosted April 26, 20121321st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona

13Hospital Readmissions Reduction ProgramProposed Modification to Payment CalculationThe hospitals DRG base payment will be modified by an Adjustment FactorThe Adjustment Factor will be the higher of either the Ratio or the Floor values (rounded to fourth decimal place)

Ratio = 1 (aggregate payment for excessive readmissions) (aggregate payment for all discharges)

Floor adjustment set at 0.9900 for FY 2013, 0.9800 for FY 2014 and 0.9700 for FY 2015 and subsequent fiscal years

1414Steps to Estimate Impact of Readmission Reduction Program at Your HospitalGo to Hospital Compare and calculate your hospitals excessive readmission ratio Calculate aggregate payments for all dischargesCalculate aggregate payments for excess readmissionsCalculate your ratio and determine your readmission adjustment factor21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona15Note that the data for the 3-year applicable period of July 1, 2008 to June 30, 2011 Has not been completed yet. CMS to post a review period before June 20, 201215Step 1: Calculate your excessive readmission ratio for each population and retrieve your population volumes from Hospital Compare Website16

16Step #2: Calculate Aggregate Payments for All Discharges(Base DRG payment x AMI volume) +$6877 x 498 = $3,424,746(Base DRG payment x CHF volume) +$6877 x 671 = $4,614,467(Base DRG payment x PN volume)$6877 x 833 = $5,728,541Aggregate payments for all discharges$13,767,75421st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona1717Step #3: Calculate Aggregate Payments for Excess Readmissions(Base DRG payment x AMI volume) x (ERR 1) =(18.0 Hospital /19.8 National) 1 = -.0909 $3,424,746 x -.0909 = < 1 = NO EXCESS PAYMENTS(Base DRG payment x CHF volume) x (ERR 1) =(24.9 Hospital /24.8 National ) 1 = .0040 $4,614,467 x .0040 = $18,606.73 in Excess Payments(Base DRG payment x PN volume) x (ERR -1) =(18.8 Hospital /18.4 National) 1 = .0217$5,728,541 x .0217 = $124,309.34 in Excess Payments Aggregate payments for excess readmissions $142,916.0721st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona18You have to perform better than the national median in all three populations in order to avoid a reduction in your DRG base payment rate18Step #4: Calculate your ratioRatio = 1 (Aggregate payments for excess readmits / Aggregate payments for all discharges)

Ratio = 1 ($142,916.07/$13,767,754)1 0.0104

Ratio = .9896

FY 2013 Floor value of 0.9900 is greater than ratio Hospital Readmission Adjustment Factor is .9900 Base Rate Decreased from $6,877 to $6,808.23

21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona1919Tips for Preparing for Readmission Reduction Program Excess readmission ratios used for Readmission Reduction Program are not identical to those posted on Hospital Compare for HIQR Program. Review confidential reports and patient level details about your hospital readmissions, which will be delivered to your secure QualityNet accounts by June 20, 2012 (30-day review period)

Only 34.5% of American hospitals will have no adjustment. Have your CFO and Quality Officer review the proposed rule in detail and comment, comment, comment to CMS on or before June 25, 2012

Review readmission patterns for your hospital wide and total knee and hip populations NOW to determine impact on your organization because these populations may be added to the Hospital Inpatient Quality Program21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona2020Proposed New Claims-Based Measures for FY 2015 Payment DeterminationHip/Knee Readmission: Hospital-Level 30-day All-Cause Risk Standardized Readmission Rate following elective primary total hip and knee arthroplasty NQF #1551

2008 Medicare FFS claims data show rates range from 3.06 to 50.94 percent (median 6.06%)Repeat hip/knee arthoplasty in 30 days excludedRisk adjusted similar to AMI, HF and PN readmission metrics2121st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona

21Proposed New Claims-Based Measures for FY 2015 Payment DeterminationHospital Wide ReadmissionAll-Cause readmissions within 30 days of dischargeSingle summary score derived from five specialties: medicine, surgery and gynecology, cardiorespiratory, cardiovascular and neurologyExclusions include planned procedures, cancer and psychiatric conditionsPending NQF endorsement20% of all Medicare beneficiaries are re-hospitalized within 30 days of dischargePreventable readmissions estimated from 12 to 76 percentIf national rates could be lowered to levels achieved by t