Medicare Fee-For-Service (FFS) Hospital Readmissions: Q Q1 2016

Transcription

1 Medicare Fee-For-Service (FFS) Hospital Readmissions: Q Q State of Please contact Barb Averyt via at or by phone at for additional information This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-11SOW-C

2 Overview Table 1: 30-Day All-Cause Readmission Rates Q Q Baseline Current (CY 2013) Q Q Q Q Q to Q ,963/160,061 6,413/39,094 5,835/35,656 6,088/38,961 6,981/44,871 25,317/158, % 16.4% 16.4% 15.6% 15.6% 16.0% Nation1 18.5% Table 2: Number of Emergency Department (ED) Visits Q Q Q Q Q Q ,675 55,840 61,752 71,653 Table 3: Number of Observation Stays Q Q Q Q Q Q ,165 12,570 13,799 14,969 1 National data are obtained from the Integrated Care for Populations and Communities (ICPC) Quarterly Scorecard and the most recent data available are through December 31, Page 1

3 Table 4: All-Cause Average Readmissions Rates by Region Region Average Rate Western 17.1% East Valley 16.8% Central Valley 16.4% West Valley 15.9% Southern 15.5% Northern 12.7% Page 2

4 Figure 1: and National Outpatient ED Visits, Observation Stays, and Inpatient Admissions 2,3 2 ED visits and observation stays resulting in an inpatient stay are not included in this calculation. 3 National data are obtained from the Integrated Care for Populations and Communities (ICPC) Quarterly Scorecard and the most recent data available are through December 31, Page 3

5 Table 5: Discharge Distribution after Inpatient Hospitalization for All Causes Q Q Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0-3 Days 4-7 Days 8-14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 14.8% 93,625 13,852 9, % 4, % 2, % 2, % 3, % 2, % 2, % SNF* 19.2% 25,047 4,800 3, % 1, % % % 1, % % 1, % HHA** 18.8% 21,272 4,004 2, % 1, % % % 1, % % % Hospice 2.2% 6, % % % % % % % Other 20.2% 12,488 2,525 1, % 1, % % % % % % Total 16.0% 158,582 25,317 17, % 8, % 4, % 4, % 6, % 4, % 4, % *Skilled Nursing Facility **Home Health Agency Figure 2: 30-Day All-Cause Readmission Rates 5 4 An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 5 National data are obtained from the Integrated Care for Populations and Communities (ICPC) Quarterly Scorecard and the most recent data available are through December 31, Page 4

6 Table 6: Discharge Distribution after Inpatient Hospitalization for Acute Myocardial Infarction (AMI) Q Q Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0-3 Days 4-7 Days 8-14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 12.9% 2, % % % % % % % SNF 22.9% % % % % % % % HHA 17.6% % % % % % % % Hospice 4.2% % % 0 0.0% % % 0 0.0% % Other 25.4% % % % % % % % Total 14.9% 4, % % % % % % % Figure 3: 30-Day AMI Readmission Rates 7 6 An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 7 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, Page 5

7 Table 7: Discharge Distribution after Inpatient Hospitalization for Heart Failure (HF) Q Q Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0-3 Days 4-7 Days 8-14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 22.1% 3, % % % % % % % SNF 24.8% % % % % % % % HHA 25.2% 1, % % % % % % % Hospice 5.1% % % % % 1 5.0% % % Other 33.1% % % % 9 9.0% % % % Total 22.5% 6,458 1,453 1, % % % % % % % Figure 4: 30-Day HF Readmission Rates 9 8 An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 9 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, Page 6

8 Table 8: Discharge Distribution after Inpatient Hospitalization for Coronary Artery Bypass Graft (CABG) Q Q Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0-3 Days 4-7 Days 8-14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 9.3% % % % % % % 2 5.1% SNF 20.3% % % % % % % % HHA 12.9% % % % % % % % Hospice 0.0% ND 0 ND 0 ND 0 ND 0 ND 0 ND 0 ND Other 19.0% % % % % % % % Total 13.7% 1, % % % % % % % Figure 5: 30-Day CABG Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 11 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, Page 7

9 Table 9: Discharge Distribution after Inpatient Hospitalization for Pneumonia (PNE) Q Q Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0-3 Days 4-7 Days 8-14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 15.3% 6, % % % % % % % SNF 22.4% 1, % % % % % % % HHA 22.9% 1, % % % % % % % Hospice 1.9% % % 0 0.0% % % % % Other 23.7% % % % % % % % Total 17.1% 11,343 1,936 1, % % % % % % % Figure 6: 30-Day PNE Readmission Rates The method for identifying PNE visits was modified; therefore, the data may not be comparable to previous reports. An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 13 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, Page 8

10 Table 10: Discharge Distribution after Inpatient Hospitalization for Chronic Obstructive Pulmonary Disease (COPD) Q Q Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0-3 Days 4-7 Days 8-14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 18.7% 3, % % % % % % % SNF 25.3% % % % % % % % HHA 23.4% % % % % % % % Hospice 5.0% % 1 9.1% % 1 9.1% % % % Other 24.5% % % % % % % % Total 19.8% 5,335 1, % % % % % % % Figure 7: 30-Day COPD Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 15 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, Page 9

11 Table 11: Discharge Distribution after Inpatient Hospitalization for Total Hip/Knee Replacement (THA/TKA) Q Q Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0-3 Days 4-7 Days 8-14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 3.6% 4, % % % % % % % SNF 6.9% 1, % % % % % % % HHA 3.8% 3, % % % % % % % Hospice 66.7% % % 0 0.0% 0 0.0% % 0 0.0% 0 0.0% Other 8.6% % % % 3 6.8% 2 4.5% % % Total 4.5% 9, % % % % % % % Figure 8: 30-Day THA/TKA Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 17 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, Page 10

12 Methodology and Data Source Information The dashboard provides information regarding your state s all-cause, acute myocardial infarction (AMI), heart failure (HF), coronary artery bypass graft (CABG), pneumonia (PNE), chronic obstructive pulmonary disease (COPD), and total hip/knee replacement (THA/TKA) 30-day readmissions. Rates are calculated using hospital inpatient claims for Medicare Fee-For-Service (FFS) beneficiaries. Planned readmissions are excluded from this analysis. Data in this report are limited to Medicare FFS Part-A data for discharges from April 1, 2015, to March 31, International Classification of Diseases (ICD)-10 codes are used to calculate rates starting from October Readmission rates in this report are not calculated using the 30-day risk standardized methodology for the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program or found on hospitalcompare.hhs.gov. Readmission rates are updated quarterly with the most current time period s data. The time periods illustrated in this document are examples only and may not reflect the most current data period. Pages 1 through 3 contain the following information. 1 Summary table 3 Regional map Emergency department (ED) visits and Outpatient ED visits, observation stays, and inpatient 2 observation stays tables 4 admissions graphs Example Dashboard (Pages 1 through 3) The Complete Standard Analytical Table (CSAT) data file was used for this analysis. The CSAT data file is provided to HSAG by CMS. The CSAT data file includes Part A and Part B claims for FFS beneficiaries. Please note that the results obtained from CSAT may vary from your own state s results. Page A

13 3 4 Example Outpatient ED Visits, Observation Stays, and Inpatient Admissions Dashboard Page B

14 1 Summary Table The summary table contains your state s Baseline and Current 30-day readmission rates, including the numerator and denominator for each quarter. All rates are calculated from Medicare inpatient claims for FFS beneficiaries. See page F for measure definitions. The summary table also includes the national rate. Due to availability of the data, the national rates may be calculated from a different time period. 2 ED Visits and Observation Stays Tables The ED visits and observations stays tables provide the count of ED visits and observations stays, respectively, for each quarter in the current report period. ED visits and observation stays resulting in an inpatient stay are not included in the counts. 3 Regional Map The state of was divided into six regions: Western (WAZ), Northern (NAZ), Southern (SAZ), West Valley Phoenix (WV Phoenix), Central Valley Phoenix (CV Phoenix), and East Valley Phoenix (EV Phoenix). Aggregate readmission rates are calculated for each region using the hospitals located in the region. The table shows regional readmission rates for each region. 4 Outpatient ED Visits, Observation Stays, and Inpatient Admissions The two graphs depict the volume of outpatient ED visits, observation stays, and inpatient admissions for the state and the nation. The purpose of each is to monitor acute care utilization at the state and national levels. The counts are calculated for quarterly periods from Medicare acute care claims for FFS beneficiaries. Claims are classified based on hierarchy rules similar to Medicare bundled payment rules. Each encounter counts as only one of three types: (1) Inpatient admission, (2) Observation stay, or (3) ED visit. Therefore, ED visits and observation stays that result in an inpatient stay are counted as an inpatient stay. ED visits that result in an observation stay, but not an inpatient stay, are counted as an observation stay. Page C

15 Pages 4 through 10 provide the following data for all-cause and disease-specific 30-day readmissions: 5 Discharge distribution table 6 Line graph Example Dashboard (discharge distribution and line graph) Discharge Distribution Table The discharge distribution table shows the 30-day readmission rates by discharge setting, the proportion of readmissions that occurred back to your hospital or another hospital, and the number of days from discharge to readmission. Readmissions from home, skilled nursing facilities (SNFs), home health agencies (HHAs), and hospice are determined by the patient discharge status on the index hospitalization claim. All other discharge status codes are bucketed into the Other category. Results for the state and your hospital s region are provided for comparison. 6 Line graph The purpose of the readmission graph is to track readmission rates over time. The Line Graph shows your state s improvement in relation to nation. Rates are calculated quarterly. Page D

16 Measure Definitions All-Cause 30-Day Readmission Rates All-cause readmission rates are calculated as the percentage of hospital admissions that occurred within 30 days of an index admission for any condition. Each hospital admission within 30 days following an index admission is considered a readmission (e.g., a beneficiary with four readmissions in the measurement period counts as four separate readmissions). Any beneficiary who dies in the hospital or is transferred to another hospital on the same day is excluded from your facility s calculation. Readmissions from home, SNFs, HHAs, and hospice are determined by the patient discharge status on the index hospitalization claim. Planned Readmissions A planned readmission is a readmission within 30 days of discharge from a short-term acute care hospital that is a scheduled part of the patient s plan of care. Planned readmissions are excluded from this report. Condition-Specific 30-Day Readmission Rates When calculating disease-specific readmission rates, an admission is included if the principal diagnosis/procedure code for the admission specifies that disease (i.e., AMI, HF, CABG, PNE, COPD, and THA/TKA). Condition-specific readmissions include all-cause admissions that occur within 30 days of an index admission for the specific condition (e.g., a beneficiary with an index admission of AMI who is readmitted for a urinary tract infection (UTI) is considered an AMI readmission). Any beneficiary who dies in the hospital or is transferred to another hospital on the same day is excluded from your facility s calculation. The following table lists the codes used to identify the discharges for AMI, HF, CABG, PNE, COPD, and THA/TKA. ED Visits and Observation Stays The following table lists the codes used to identify ED visits and observations stays. Revenue Codes ED Visits 0450, 0451, 0452, 0456, 0459, 0981 HCPCS Observation Stays 0762, 0760 AND G0378 Page E

17 Hospitals by Region Central Valley ABRAZO CENTRAL CAMPUS ABRAZO SCOTTSDALE CAMPUS ARIZONA STATE HOSPITAL BANNER - UNIVERSITY MEDICAL CENTER PHOENIX CAMPUS HONORHEALTH DEER VALLEY MEDICAL CENTER HONORHEALTH SCOTTSDALE SHEA MEDICAL CENTER BANNER BEHAVIORAL HEALTH HOSPITAL HONORHEALTH JOHN C LINCOLN MEDICAL CENTER HONORHEALTH SCOTTSDALE THOMPSON PEAK MEDICAL CENTER HAVEN SENIOR HORIZONS HONORHEALTH SCOTTSDALE OSBORN MEDICAL CENTER MARICOPA MEDICAL CENTER MAYO CLINIC HOSPITAL OASIS HOSPITAL PHOENIX INDIAN MEDICAL CENTER QUAIL RUN BEHAVIORAL HEALTH ST JOSEPH'S HOSPITAL AND MEDICAL CENTER ST LUKE'S BEHAVIORAL HOSPITAL ST LUKE'S MEDICAL CENTER THE CORE INSTITUTE SPECIALTY HOSPITAL VALLEY HOSPITAL East Valley ARIZONA ORTHOPEDIC AND SURGICAL SPECIALITY HOSP ARIZONA SPINE AND JOINT HOSPITAL AURORA BEHAVIORAL HEALTHCARE-TEMPE BANNER BAYWOOD MEDICAL CENTER BANNER CASA GRANDE MEDICAL CENTER BANNER DESERT MEDICAL CENTER BANNER GATEWAY MEDICAL CENTER BANNER GOLDFIELD MEDICAL CENTER BANNER HEART HOSPITAL BANNER IRONWOOD MEDICAL CENTER CHANDLER REGIONAL MEDICAL CENTER FLORENCE HOSPITAL AT ANTHEM, LLC GILBERT HOSPITAL HUHU KAM MEMORIAL HOSPITAL MERCY GILBERT MEDICAL CENTER MOUNTAIN VISTA MEDICAL CENTER, LP OASIS BEHAVIORAL HEALTH HOSPITAL Northern BANNER PAYSON MEDICAL CENTER CHINLE COMPREHENSIVE HEALTH CARE FACILITY COBRE VALLEY REGIONAL MEDICAL CENTER COMMUNITY COUNSELING CTRS INC AT PINEVIEW HOSPITAL FLAGSTAFF MEDICAL CENTER FORT DEFIANCE INDIAN HOSPITAL HOPI HEALTH CARE CENTER LITTLE COLORADO MEDICAL CENTER PAGE HOSPITAL SAGE MEMORIAL HOSPITAL SAN CARLOS INDIAN HOSPITAL SUMMIT HEALTHCARE REGIONAL MEDICAL CENTER THE GUIDANCE CENTER TUBA CITY REGIONAL HEALTH CARE CORPORATION VERDE VALLEY MEDICAL CENTER WHITE MOUNTAIN REGIONAL MEDICAL CENTER WHITERIVER PHS INDIAN HOSPITAL WINDHAVEN PSYCHIATRIC HOSPITAL YAVAPAI REGIONAL MEDICAL CENTER-EAST CAMPUS BANNER-UNIVERSITY MEDICAL CENTER SOUTH CAMPUS YAVAPAI REGIONAL MEDICAL CENTER-WEST CAMPUS Southern BANNER-UNIVERSITY MEDICAL CENTER TUCSON CAMPUS BENSON HOSPITAL CANYON VISTA MEDICAL CENTER CARONDELET HOLY CROSS HOSPITAL CARONDELET ST JOSEPH'S HOSPITAL CARONDELET ST. MARY'S HOSPITAL COPPER QUEEN COMMUNITY HOSPITAL GREEN VALLEY HOSPITAL MT GRAHAM REGIONAL MEDICAL CENTER NORTHERN COCHISE COMMUNITY HOSPITAL NORTHWEST MEDICAL CENTER ORO VALLEY HOSPITAL PALO VERDE BEHAVIORAL HEALTH SELLS INDIAN HEALTH SERVICE HOSPITAL SONORA BEHAVIORAL HEALTH HOSPITAL SOUTHEAST ARIZONA MEDICAL CENTER TUCSON MEDICAL CENTER West Valley ABRAZO ARROWHEAD CAMPUS ABRAZO MARYVALE CAMPUS ABRAZO WEST CAMPUS ARIZONA GENERAL HOSPITAL AURORA BEHAVIORAL HEALTH SYSTEM BANNER BOSWELL MEDICAL CENTER BANNER DEL E WEBB MEDICAL CENTER BANNER ESTRELLA MEDICAL CENTER BANNER THUNDERBIRD MEDICAL CENTER WICKENBURG COMMUNITY HOSPITAL Western HAVASU REGIONAL MEDICAL CENTER KINGMAN REGIONAL MEDICAL CENTER LA PAZ REGIONAL HOSPITAL PARKER INDIAN HEALTH CENTER VALLEY VIEW MEDICAL CENTER WESTERN ARIZONA REGIONAL MEDICAL CENTER YUMA REGIONAL MEDICAL CENTER Page F