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
Slide 2
Potentially Preventable Readmissions Added in DataVision Web
Application in May! 21st Annual Midas+ User Symposium May 2023,
2012 Tucson, Arizona 2
Slide 3
Report Parameters Allow You to Run Reports for 15 or 30 Day
Readmissions 3 21st Annual Midas+ User Symposium May 2023, 2012
Tucson, Arizona
Slide 4
Potentially Preventable Readmissions Added to APR DRG Service
Line Profile 21st Annual Midas+ User Symposium May 2023, 2012
Tucson, Arizona 4
Slide 5
Readmissions Tab added to APR DRG Subclass Detail Report in May
21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona
5
Slide 6
More PPR Reports Coming in July Adding Tab for Saved
Readmissions 6 21st Annual Midas+ User Symposium May 2023, 2012
Tucson, Arizona
Slide 7
APR DRG Encounter Level Data Now being provided to all
DataVision clients Separate license with 3M not required Data
planted back on your server in May 2012 Transitioning to monthly
plant back in August so that data will be 2 months old instead of
six Standard 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, Arizona 7
Slide 8
And it just keeps getting better More Cool Stuff Under
Construction! PPRs to be added to Physician Reports in the
DataVision Web Application in October 2012 Potentially Preventable
Complications to be added in January 2013 DataVision Web Update PPC
Server based reports for patient drill down planned for May 2013
21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona
8
Slide 9
Benefits of 3M Potentially Preventable Readmissions &
Complications Focuses attention on cases that you can affect
through improved clinical and care management processes Helps you
understand the needs of your key populations Trended PPR & PPC
performance more sensitive to performance improvement initiatives
Optimally used with APR DRG LOS and Mortality findings to
understand changing populations 9 21st Annual Midas+ User Symposium
May 2023, 2012 Tucson, Arizona
Slide 10
Training Webinars for APR DRG PPRs June 13, 2012 - 10:30 am
Pacific Time June 15, 2012 - 8:30 am Pacific Time June 21, 2012 -
1:30 pm Pacific Time Register on the Midas+ Clients Only Website
21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona
10
Slide 11
Hospital Readmissions Reduction Program Begins 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 Readmission NQF #0330 Heart Failure 30-day
Risk Standardized Readmission NQF #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,
Arizona 11
Slide 12
CMS Readmission Risk Adjustment Methodology Patient demographic
factors Co-morbid diagnoses and indicators of frailty Data source
is from Medicare Part A and B claims (excluding Medicare Advantage)
12 months prior to and including the index admission Discharges
July 1, 2008 to June 30, 2011 will be used by CMS to calculate the
excess readmission ratios used to determine payment in FY 2013
Midas+ can NOT replicate this measure Methodology is available at:
http://qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPubli
c%2FPage%2FQnetTier4&cid=1219069855841http://qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPubli
c%2FPage%2FQnetTier4&cid=1219069855841. 21st Annual Midas+ User
Symposium May 2023, 2012 Tucson, Arizona 12
Slide 13
Review of Proposed IPPS Rule CMS-1588-P Posted April 26, 2012
13 21st Annual Midas+ User Symposium May 2023, 2012 Tucson,
Arizona
Slide 14
Hospital Readmissions Reduction Program Proposed Modification
to Payment Calculation The hospitals DRG base payment will be
modified by an Adjustment Factor The 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 14
Slide 15
1.Go to Hospital Compare and calculate your hospitals excessive
readmission ratio 2. Calculate aggregate payments for all
discharges 3.Calculate aggregate payments for excess readmissions
4.Calculate your ratio and determine your readmission adjustment
factor 21st Annual Midas+ User Symposium May 2023, 2012 Tucson,
Arizona 15 Note 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, 2012
Slide 16
Step 1: Calculate your excessive readmission ratio for each
population and retrieve your population volumes from Hospital
Compare Website 16
Slide 17
Step #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 = $5,728,541 Aggregate payments for all
discharges $13,767,754 21st Annual Midas+ User Symposium May 2023,
2012 Tucson, Arizona 17
Slide 18
Step #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 $142,916.07
21st Annual Midas+ User Symposium May 2023, 2012 Tucson, Arizona 18
You have to perform better than the national median in all three
populations in order to avoid a reduction in your DRG base payment
rate
Slide 19
Step #4: Calculate your ratio Ratio = 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, Arizona 19
Slide 20
Tips 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
Program 21st Annual Midas+ User Symposium May 2023, 2012 Tucson,
Arizona 20
Slide 21
Proposed New Claims-Based Measures for FY 2015 Payment
Determination Hip/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 excluded Risk adjusted similar to
AMI, HF and PN readmission metrics 21 21st Annual Midas+ User
Symposium May 2023, 2012 Tucson, Arizona
Slide 22
Proposed New Claims-Based Measures for FY 2015 Payment
Determination Hospital Wide Readmission All-Cause readmissions
within 30 days of discharge Single summary score derived from five
specialties: medicine, surgery and gynecology, cardiorespiratory,
cardiovascular and neurology Exclusions include planned procedures,
cancer and psychiatric conditions Pending NQF endorsement 20% of
all Medicare beneficiaries are re-hospitalized within 30 days of
discharge Preventable readmissions estimated from 12 to 76 percent
If national rates could be lowered to levels achieved by top
performing regions $1.9 billion saved annually 22 21st Annual
Midas+ User Symposium May 2023, 2012 Tucson, Arizona Measure
specifications can be found on NQF Website at
http://www.qualityforum.org/Projects /Readmissions_Endorsement_
Maintenance.aspx