Steven J. Korzeniewski, PhD-Candidate, MSc, MA,Director, Statistical Analysis Resource Group (SARG) & Chief Scientific Officer,

22670 Haggerty Rd Ste. 100, Farmington Hills, MI 48335Telephone: (248) 465-7365, Email: skorzeniewski@mpro.org 

Background:• Most US hospitals are unable to identify their patients that readmit to other

hospitals. [Jencks SF, Williams MV, Coleman EA. Rehospitalizations Among Patients in the Medicare Fee-for-service Program.

N Engl J Med. 2009;360:1418-1428.]

• Hospitals lacking access to data on their patients that readmit elsewhere are unable to:

Calculate their total readmission ratesInvestigate trendsEvaluate performance

• National interest in reporting is mounting, particularly following the recent and historic passage of healthcare reform legislation.

CMS now reports risk standardized rates for selected conditions, but these represent a minority of overall readmissions

An infrastructure capable of such reporting did not exist in Michigan, Until NOW….

Mission:Coordinate multi-payer data sharing to construct readmission profiles for Michigan hospitals and assist them in evaluating intervention effectiveness.

Structure:Led by MPRO’s Statistical Analysis Resource Group Director, includes:

-analysts from many of Michigan’s health plans

-representatives from hospitals, universities and the Michigan Health & Hospital Association.

-Dr. Stephen Jencks, IHI Consultant, participates at times as well.

Accomplishments:During bi-weekly meetings, the data workgroup has devised both a data extract procedure and readmissions reporting template.

Data extract procedureStandardized program for pulling member-level data that defines and categorizes readmissions.

Readmissions Reporting TemplatePresents a wealth of readmissions information within a single page layout.

Data Extract Procedure:Health plans extract member-level data for all acute care admissions from their respective systems.

Admissions are sorted sequentially and categorized as ‘at risk’ or ‘not at risk’ of readmission.

Admissions not at risk of rehospitalization include:Transfers to another inpatient facility (i.e., rehabilitation, skilled nursing or hospice), those ending in a patient’s death or in the patient leaving the hospital against medical advice, and admissions occurring within 30 days of the end of the data period.

Remaining admissions are considered at risk of readmission.

Data Extract Procedure:Data Elements of Interest

Unique Identification Number per Patient

DRG (and contributing elements) Patient Zip Code

Unique Identification Number per Admission

Name of Hospital Principal ICD-9 Diagnosis Code

Type of Bill Hospital NPI number Principal ICD-9 Procedure Code

Admission Date Type of AdmissionProduct Group (commercial or Medicaid/Medicare)

Discharge Date Patient GenderFollow-up Care (inpatient/outpatient)

Discharge Status Number Patient Age in Years Enrollment Date

MSDRG (and contributing elements)

Patient Date of Birth Disenrollment Date

Reporting Template:• Data are currently transmitted in summary form to

MPRO whom aggregates the information to populate the final readmissions report template.

The next slide depicts the 2008 calendar year data.

Disseminated reports include technical specifications and a detailed narrative describing data accompanied in the report.

Reporting Template:

8

Time Period: CY2008Payers: HAP, Health Plus, Medicaid, Priority Health, Medicare, BCN, BCBSM

PRODUCT Line

See Data Definitions for Column Descriptionsa b c d e f g h I

AGE GROUPType of Index Admission

Discharges at Risk

RA to the Same Hospital RA to a Different Hospital RA to Any Hospital

    N N % N % N %

Commercial

AdultM 81,735 8,659 10.6% 2,844 3.5% 11,505 14.1%S 84,878 4,480 5.3% 1,123 1.3% 5,603 6.6%O 41,667 997 2.4% 174 0.4% 1,171 2.8%

PediatricM 11,260 774 6.9% 194 1.7% 968 8.6%S 3,537 181 5.1% 32 0.9% 213 6.0%O 547 20 3.7% 6 1.1% 26 4.8%

Post-neonatal M 3,173 196 6.2% 58 1.8% 254 8.0%S 878 52 5.9% 24 2.7% 76 8.7%

Neonatal M 24,935 286 1.1% 149 0.6% 435 1.7%S 386 26 6.7% 10 2.6% 36 9.3%

Total 252,996 15,671 6.2% 4,614 1.8% 20,287 8.0%

Medicaid FFS (managed care data not shown for presentation

purposes)

AdultM 64,017 5,234 8.2% 2,134 3.3% 7,368 11.5%S 18,513 1,013 5.5% 317 1.7% 1,330 7.2%O 31,200 940 3.0% 203 0.7% 1,143 3.7%

PediatricM 7,039 1,406 20.0% 104 1.5% 1,510 21.5%S 1,296 131 10.1% 13 1.0% 144 11.1%O 1,151 35 3.0% 13 1.1% 48 4.2%

Post-neonatal M 2,472 233 9.4% 86 3.5% 319 12.9%S 355 51 14.4% 11 3.1% 62 17.5%

Neonatal M 31,498 347 1.1% 403 1.3% 750 2.4%S 73 5 6.9% 5 6.9% 10 13.7%

Total 157,614 9,395 6.0% 3,289 2.1% 12,684 8.1%

Medicare (FFS)Adult M 280,012 45,250 16.2% 11,657 4.2% 56,907 20.3%

S 117,311 9,797 8.4% 2,712 2.3% 12,509 10.7%Total 398,836 55,419 13.90% 14,573 3.7% 69,992 18.0%

Total by Age Group Adult 737,544 78,696 10.7% 21,884 3.0% 100,583 13.6%Pediatric 26,378 2,591 9.8% 369 1.4% 2,960 11.2%Post-neonatal 7,365 553 7.5% 183 2.5% 736 10.0%Neonatal 58,481 702 1.2% 581 1.0% 1,283 2.2%

Grand Total 829,768 82,542 9.9% 23,017 2.8% 105,562 12.7%

Information Otherwise Unavailable

Reporting Template:

9

Data Description These data are 30-day all-cause acute care readmissions by age and type of initial discharge. These rates are not adjusted or standardized in any way; accordingly, rates are not intended for comparison of different facilities. Calculated rates include both scheduled and unscheduled readmissions due to difficulties in defining and removing ‘scheduled’ readmissions. Discharges that did not result in transfer to another acute care facility are counted in column ‘c’ and constitute the denominator of the readmission rates listed in columns ‘e’, ‘g’ and ‘I’. Patients having left against medical advice are not excluded from these data because they are potential targets of quality improvement interventions; this is expected to have minimal impact, if any, on the reported rates. Same-day readmissions are counted as 30-day all-cause readmissions to ensure a broad view of potential qualitiy improvement opportunities is provided. Medicaid & Medicare eligible beneficiaries are reported by Medicaid. Above average numbers of patients having scheduled admissions within 30-days of discharge (i.e., certain types of cancer patients, patients with gastrointestinal disorders scheduled for surgery later, etc. ) will increase the readmission rates reported here. We are working towards refining our efforts to remove scheduled readmissions from future reports.

Brief Data Definitions (coloumn descriptions) - Expanded Definitions Available in 'Definitions Tab'

a Age at time of discharge: Neonatal: birth <= Age <1 month; Post-neonatal: 1 month <= Age < 1 year; Pediatric:1 year <= Age < 18 years; Adult: 18 years <= Age.

b Categorization of initial discharge following acute care admission; M=Medical, S=Surgical, O=Obstetric

c Number of acute care discharges that were not transferred to other acute care centers & were not the result of the patient leaving against medical advice.

d Number of acute care readmissions within 30-days of discharge where the patient was admitted to the hospital of discharge

e Percent of acute care readmissions within 30-days of discharge where the patient was admitted to the hospital of discharge

f Number of acute care readmissions within 30-days of discharge where the patient was admitted at a hospital other than the discharge hospital.

g Percent of acute care readmissions within 30-days of discharge where the patient was admitted to a hospital other than the discharge hospital

h Total number of acute care readmissions within 30-days of discharge.

22670 Haggerty Road, Suite 100, Farmington Hills, MI 48335 ~ www.mpro.org

Current Activities:

• Pilot reports have been disseminated.

• Plans are reporting aggregate data by calendar year quarter from 2006-2010 Initial reports due to be disseminated shortly will include a facility level

crude trend analysisStatewide profiles will also be disseminated for comparative purposes

• We are drafting data use agreements to facilitate claim-level data sharing Most plans have verbally agreed to share these data, although full approval has

yet to be received. Some have already processed letters of commitment to do so

• We are seeking external funding to engage the ReWaRD towards evaluation of existing and newly implemented MI STA*AR interventions given that no other data source in Michigan can support such analyses.

22670 Haggerty Road, Suite 100, Farmington Hills, MI 48335 ~ www.mpro.org

Member Level Data Sharing:

■ Allows for development of a comprehensive analytic file of virtually all readmissions in Michigan.►Facilitates exploration of

♦ Risk standardization methods♦ Methods of defining ‘preventable’ readmissions♦ Evaluation of interventions (Provider and Payer level)

22670 Haggerty Road, Suite 100, Farmington Hills, MI 48335 ~ www.mpro.org

Overall Conclusions:• The Rehospitalization Workgroup for Reporting Data is a subcommittee

tasked with facilitating multi-payer data sharing ■ While the original mission was to provide readmission reports to all

Michigan hospitals, it is now expanding to include evaluation of readmission reduction initiatives through application of epidemiologic methods.

• Barriers and other considerations include funding, HIPPA concerns, and data access issues.

QUESTIONS?