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Use of the NYSPFP 3M PPR Reports
Readmission Analysis and Diagnostics
A partnership of the Healthcare Association of New York State
and the Greater New York Hospital Association
Gloria Kupferman
Nancy Landor
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Agenda
Item Facilitator
Introduction Zeynep Sumer-King
Review of the 3M PPR (Potentially
Preventable Report) Structure Gloria Kupferman
Brief Exercises - turning the data into
information
• Major Medical Center (blinded
and non NYS)
• Small Community Hospital
(blinded and non-NYS)
• Physician Example
Nancy Landor
Questions and Answers Loretta Willis
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What is a Readmission?
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Methodologies
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3M™ PPR Methodology
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3M™ PPR Methodology
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Observed PPR Rate
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Expected PPR Rate
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Observed to Expected Ratio
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Hospital Severity-Adjusted Rate
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Live Tour
o Information Tabs
o Functionality
o Use of Filters
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Readmission Diagnostic Report
Turning Data into Information
Brief Exercises:
o Blinded Non-NYS Major Academic Hospital
o Blinded Non-NYS Small Community Hospital
o Physician Profiles
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Readmission Reduction: Optimizing the Reports
Continuum of ReadmissionReduction Work
Hospital ReadmissionManagement
(NYSPFP Pilot)
Care Delivery and use of “Any Risk” model to
mitigate risk and prepare patient from admission
High Risk for the purpose of Post Hospital Care Planning and Services
Readmission Bundle
Elements
Data Analysis and Diagnostics
Feed information for:
Special Protocols/Services
Practice Patterns
For redesign or new development
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Academic Hospital – Review of Service Line
Other than “Quitting” - Where do you start?
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Service Line Diagnostics
Priority findings:o Cardiac Service Line (PCI, CABG and general cardiology)
o Gastroenterology
o General Surgery ** need to explore at DRG level
o General Medicine ** need to explore at DRG level
HUM. . .. Possible specialty areas that could be ask for more information
o OB/GYN
o Hematology (explore oncology or sickle cell, etc.)
o Renal Failure (explore the delivery system)
What’s up with Ortho/Neuro?
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Cardiac Service Line
↑ PCI readmission rate
↑ High volume common cardiac diagnosis
o Ask Cardiology to explore (with facilitator) a subgroup of those patient to
look from commonalities that could be addressed in the care delivery
system for that specific population.
o Focus group with cardiac cath, MD, and nursing staff - get some pearls
o Post hospital calls or hot line. . . Survey information.
o Confounding issue since most of the hospitals has very high readmission
rate, the problem could be endemic to the hospital systems and community
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General Medicine Service Line
Interesting, the bulk of the issue is in APR_DRG 861: S/S’s and other factors
impacting the patient’s health (fatigue, edema) and medicine poisoning,
allergic reactions. . ..
o Early guess: Relationship with medication management is likely significant
o Explore root causes. . .
o
Presume med mgmt. is at the major practice pattern issueo Pharmacist assistance in medication management, high risk medication management
teams, and/or medication reconciliation and education at discharge
o Explore the use of observation Hydration
Diuresis
Medication Titration
o Additional education or community services
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Gastroenterology
Gastro:o Seems to point to liver/pancreas disease population and possible
compliance/integrated services (SA/MH)
o Palliative Care
o Maybe pediatric N/V
o Depending on findings. . . Refer to areas that could address
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Endocrinology
Endoo DRG 422 Electrolyte Imbalance: elderly, pediatric or other pattern
o Diabetes: A lot of diabetes admissions and readmission. . . That is very likely an
omission of some programming ( Med. Mgmt., CDE, Nutrition, med management,
Teaching/DSMT or ? Primary / Pediatric care)
o Any similarities or connection to the general medicine priority areas
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General Surgery
High across all procedures (high and low volume)
o Confounding hospital systems. . . perhaps start in surgery to work on
hospital-wide readmissions issues.
o Need to really explore the delivery system:o Pre-admission testing, readiness, teaching, and preparation
o HAC/HAI as causal factors
o Patient education on self management
o Wound care
o Targeted PHC (Post hospital Care) services based on needs identified.
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Other:
OB/GYNo Even NVD has high readmit rate???
o Request by Medical Staff and Nurse Executives. . .
o Explore and determine the root causes and possible opportunities for care
delivery/system changes
o Again. . . Focus group with surgeons and nurses
HEMATOLOGYHave enough sickle-cell readmission to look into hospital and post hospital evidence
based protocols and opportunities
RENAL DIALYSISMay have more serious problems in other areas but these programs can frequently find
their own issues and make changes
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Point of Origin and Discharge Disposition
o Coding improving in these areas
o Secondary assistance in finding coding issues
o Hospitals have been comfortable going through
these tabs to look at high level practice patterns
o Ortho/Neuro (use of LTC?)o N=11 at risk THR patients discharged to LTC/other.
o Fair amount of patients going home with no services
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Small Community Hospital
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Physician Profiles Academic Medical Center # 2 Blinded
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Physician DRG 173
Service Line APR-DRGPhysician by APR- DRG
Highest Volume Surgeon. . . Great outcome?
What is same/different between MD 141 and MDs 37,50, and 176
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DRG 175 Percutaneous Cardiovascular Procedures w/o AMI
APR DRGAPR DRG Description /
Attending Physician
At Risk
Admissions
Readmission
Chains
Observed PPR
Rate
Expected PPR
Rate
Observed/
Expected RatioHospital
175 Physician 211 1 1 100.0% 7.1% 14.12 96.7%
Physician 109 1 1 100.0% 7.1% 14.12 96.7%
Physician 40 1 1 100.0% 7.1% 14.12 96.7%
Physician 241 2 1 50.0% 5.6% 8.96 61.3%
Physician 176 1 1 100.0% 13.9% 7.18 49.1%
Physician 195 3 1 33.3% 9.4% 3.56 24.4%
Physician 1 3 1 33.3% 10.7% 3.13 21.4%
Physician 158 24 4 16.7% 6.0% 2.76 18.9%
Physician 26 7 1 14.3% 5.4% 2.66 18.2%
Physician 11 11 2 18.2% 7.7% 2.37 16.2%
Physician 150 5 1 20.0% 8.5% 2.37 16.2%
Physician 28 3 1 33.3% 14.9% 2.24 15.4%
Physician 233 9 1 11.1% 9.0% 1.23 8.4%
Physician 53 50 5 10.0% 8.4% 1.19 8.1%
Physician 17 6 1 16.7% 14.9% 1.12 7.7%
Physician 5 14 1 7.1% 6.6% 1.09 7.5%
Physician 133 13 1 7.7% 7.8% 0.98 6.7%
Physician 208 31 2 6.5% 8.1% 0.79 5.4%
Physician 134 32 2 6.3% 8.3% 0.75 5.1%
Physician 229 15 1 6.7% 9.2% 0.72 4.9%
Physician 167 25 0 0.0% 6.8% 0.00 0.0%
Physician 234 10 0 0.0% 4.7% 0.00 0.0%
Physician 68 5 0 0.0% 7.3% 0.00 0.0%
Physician 164 5 0 0.0% 7.4% 0.00 0.0%
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Tips
o Use for focus groups. . . What goes well and
where are the opportunities
o Very easy to use diagnostic tool
o Let the CMO, Dept. Chairs, Nurse Leads. . .
o Play with it
o Formally analyze
o Provide feedback
o Share with MD/RN and other key clinicians
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Questions and Answers
Don’t forget to
register your team
for the NYSPFP
Readmission
Reduction
Capstone Session
