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3/16/2018

Understanding Your Facility-Specific Readmission Profile Data. Thursday, February 22, 2017. Presented by: Melanie Akin, EDS CRC Technical Advisor, Behavioral Health. 3/16/2018. 1. Background.

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3/16/2018

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  1. Understanding Your Facility-Specific Readmission Profile Data Thursday, February 22, 2017 Presented by: Melanie Akin, EDS CRC Technical Advisor, Behavioral Health 3/16/2018 1

  2. Background • All cause readmissions to acute care settings following discharge from an Inpatient Psychiatric Facility (IPF) is both undesirable for the patient and costly to Medicare. • Medicare claims from Sept 2014 until August 2016 show that among IPF admissions for Medicare beneficiaries, 20% resulted in a readmission within 30 days • Readmission represents a severe deterioration in a patient’s mental and/or physical health status

  3. Background (continued) • Readmissions expose patients to the risk of healthcare-acquired complications that they otherwise would not be exposed to • Not all admissions are preventable, yet evidence shows improvements in quality of care for patients in the IPF setting can reduce readmission rates • Decreases would reduce the burden on patients and caregivers and costs to Medicare

  4. Measure Development • As a result, the Centers for Medicare and Medicaid Services (CMS) contracted with Health Services Advisory Group (HSAG) • Developed a measure that evaluates readmission rates following IPF stays and promotes facility-level quality improvement

  5. Process • CMS conducts dry runs of some new outcome measures • Familiarizes facilities with measure results prior to public reporting on Hospital Compare • CMS provided each IPF with a private IPF-Specific Report from the dry run of the 30-Day All Cause Unplanned Readmission Following Psychiatric Hospitalization in an Inpatient Psychiatric Facility (IPF Readmission) measure

  6. Reports Overview • Medicare data is from September 1, 2014 until August 31, 2016 time period • Involved data of unplanned readmissions to an acute care setting within 30 days of discharge from the IPF index admission • Adjusts for patient risk factors and case mix differences across facilities

  7. Reports Overview(continued) • Report is an Excel file • Includes facility-level results, readmission characteristics, risk factors, and discharge level data for all patients counted in the measure • The first public reporting of the measure on Hospital Compare will be in December 2018 • Public reporting will be calculated using a measurement period from July 1, 2015 through June 30, 2017 (retrospective reporting)

  8. Measure Information and User Guide • The IPF-Specific Report and Measure Information and User Guide is available through each facility’s QualityNetSecure Portal

  9. IPF Readmission Rate • A facility-level measure • Estimates an unplanned, 30-day, risk-standardized readmission rate for adult Medicare fee-for-service (FFS) patients with a principal discharge diagnosis of a psychiatric disorder. • Claims-based and calculated by CMS • Measurement period: cases identified in the measure population over a 24 month period • Medicare FFS data from the start of the measurement period through 30 days following the measurement period are used to identify readmissions

  10. IPF Readmission Rate(continued) • Medicare FFS data from 12 months prior to the start of the measurement period through the measurement period are used to identify risk factors. • All IPFs paid under the Prospective Payment System (IPF PPS) are included in the measure. • Includes freestanding psychiatric facilities and inpatient psychiatric units in acute care or critical access hospitals (CAHs) that provide inpatient psychiatric services reimbursed by Medicare.

  11. Non-Participating IPFs • Not participating in the IPFQR program will result in a 2.0 percentage point reduction of their annual update to the standard federal rate for that year. • The program was implemented on October 1, 2012 to improve the quality of inpatient psychiatric care and communicate information to consumers to help them make informed decisions about their healthcare options

  12. Measure Description • This facility-level measure estimates an unplanned, 30-day, risk-standardized readmission rate for adult Medicare FFS patients with a principal discharge diagnosis of a psychiatric disorder. Data Source • CMS uses administrative claims data for Medicare FFS patients to calculate the measure rates.

  13. Target Population • Adult Medicare FFS beneficiaries admitted to an IPF • Measure based on all eligible index admissions from the target population. • Index admission: any eligible admission to an IPF during measurement period to which the readmission is attributed

  14. Inclusion Criteria • Age 18 or older at admission • Discharged alive • Enrolled in Medicare FFS Parts A and B during the 12 months before the admission date, month of admission, and at least one month after the month of discharge from the index admission

  15. Inclusion Criteria (continued) • Discharged with a principal diagnosis of psychiatric illness included in one of the Agency for Healthcare Research and Quality (AHRQ) Clinical Classification Software (CCS) ICD-9 and ICD-10 groupings. More information on CCS groupings is available at: https://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. • The AHRQ CCS software identifies 15 psychiatric clinical condition groups (650-670). Accordingly, we define admission for psychiatric causes as any index admission with a principal discharge diagnosis that is included in CCS 650-670 (Table A).

  16. Table A. Principal discharge diagnosis clinical categories designating psychiatric illness Diagnosis CCS Description 650Adjustment Disorders 651Anxiety Disorders 652Attention-deficit, conduct, and disruptive behavior disorders 653Delirium, dementia, and amnestic and other cognitive disorders 654Developmental disorders 655Disorders usually diagnosed in infancy, childhood, or adolescence 656Impulse control disorders, NEC 657Mood disorders 658Personality disorders 659Schizophrenia and other psychotic disorders 660Alcohol-related disorders 661Substance-related disorders 662Suicide and intentional self-inflicted injury 663 Screening and history of mental health and substance abuse codes 670 Miscellaneous disorders

  17. Exclusion Criteria • Discharged against medical advice (IPF may have limited opportunity to complete treatment and prepare for discharge) • Unreliable demographic and vital status data defined as: • Age greater than 115 years • Missing gender • Discharge status of “dead” but with subsequent admissions • Death date prior to admission date • Death date within the admission and discharge dates but the discharge status was not “dead”

  18. Exclusion Criteria (continued) • With readmissions on the day of discharge or day following discharge because those readmissions (likely transfers to another inpatient facility.) The hospital that discharges the patient to home or a non-acute care setting is accountable for subsequent readmissions. • With readmissions two days following discharge (readmissions to the same IPF within two days of discharge are combined into the same claim as the index admission and do not appear as readmissions due to the interrupted stay billing policy. Therefore, complete data on readmissions within two days of discharge are not available)

  19. Outcome Definition • Readmission: any unplanned admission, for any reason, to an IPF or a short-stay acute care hospital (including critical access hospitals) that occur within 30-days of discharge from an eligible IPF index admission. • Select procedures and diagnoses are always considered planned. • Some procedures are considered either planned or unplanned depending on the accompanying principal discharge diagnosis.

  20. Measure Calculation • Hierarchical logistic regression: estimates a risk-standardized readmission rate (RSRR). • Adjusts for risk factors and provides a hospital-specific intercept= reflects quality of care received after adjusting for case mix and the principal cause for hospitalization.

  21. Risk Adjustment • Demographics • Principal discharge diagnosis of the IPF index admission • Comorbidities • Other risk factors specific to the IPF patient population

  22. Measure Calculation (continued) • Step 1: Standardized risk ratio (SRR) calculated from the predicted number of readmissions over the expected number of readmissions. • The predictednumber of readmissions is based on the facility’s performance with its observed case mix of risk factors. • The expectednumber of readmissions is based on the national performance conditional on the same case mix of risk factors as that facility.

  23. Measure Calculation (continued) • An SRR greaterthan 1: worse quality of care compared to the national readmission rate. • An SRR less than 1: better quality of care compared to the national readmission rate. • The SRR is then used to calculate the RSRR by multiplying the SRR by the national readmission rate.

  24. Understanding IPF Performance • The RSRR and corresponding 95% interval estimate is calculated for each IPF. • Measure performance is categorized as: • better than the national rate, • no different than the national rate, • worse than the national rate, or • number of cases too small. Performance is based on the overlap of the IPF’s 95% interval estimate with the observed national readmission rate. Table B provides definitions for each of those performance categories. Table B. Performance Category

  25. Table B. Performance Category Definitions

  26. Accessing Your Report Instructions on how to load your report can be found at: https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1228772864247 • Archived IPF Readmission Measure Dry Run Information link • Measure Information and User Guide for the IPF-Specific Report • Section: Retrieving Report from QualityNet instructions

  27. IPF Specific Report Details • The IPF-Specific Report Excel file consists of six worksheets: • Summary • Publicly Reported • Facility Performance • Readmit Characteristics • Risk Factor Distribution, and • Discharge-Level Data.

  28. Worksheet 1: Summary • Provides general information on the measure, links to resources, and contact information to provide feedback on the results. • Disclaimers about the handling of the protected information contained in the report. • Facilities are encouraged to check the accuracy: • IPF Name, • CMS certification number (CCN) • and the state If discrepancies are identified, please contact PQM@hsag.com before continuing to review the report.

  29. Worksheet 2: Publicly Reported Performance Data • Worksheet 2 (Figure 1): performance on the IPF Readmission measure and comparisons to state- and national-level rates. • The Worksheet 2 information: only information in the IPF-Specific Report that will be publicly reported on Hospital Compare in reporting years. • Information in subsequent worksheets: provided to IPFs to help better understand their results. • Table 1 of Worksheet 2 includes: the facility’s comparative performance, number of index admissions, RSRR, and the national observed unplanned readmission rate.

  30. Worksheet 2: Publicly Reported Performance Data Figure 1. Example of Worksheet 2. Table 2 • Table 2 of Worksheet 2:information about national and state performance categories for the measure. • Descriptions of the data elements in Figure 1 are provided in Table Cfollowing the Worksheet 2 example.

  31. Descriptions of the data elements in Figure 1 are provided in Table C following the Worksheet 2 example. Table C.Data Description for Worksheet 2

  32. Worksheet 3: Facility Performance • Worksheet 3 (Figure 2) includes three tables. • Table 3: data points used to calculate your facility’s RSRR as described in the Measure Calculation section.

  33. Worksheet 3: Facility Performance • Table 4is the distribution of 30-Day IPF Readmission rates across the nation. Includes descriptive statistics such as minimum and maximum rates and select percentiles for both the observed unplanned readmission rate and the RSRRs. • Statistics are based on IPFs with at least 25 eligible index admissions.

  34. Worksheet 3: Facility Performance • Table 5: facility’s percentile ranking among all IPFs in the nation. Percentiles are provided for the observed unplanned readmission rate and the RSRR for IPFs with at least 25 eligible index admissions. (Descriptions of each of the data elements in Figure 2 are provided in Table D.) Figure 2. Example of Worksheet 3

  35. Table D. Data Description for Worksheet 3

  36. Worksheet 4: Readmit Characteristics Figure 3. Example of Worksheet 4, Table 6 • Worksheet 4 contains 6 tables that provide information on readmissions. • Table 6 summarizes characteristics of facilities to which patients are readmitted following discharge from your facility and following discharges nationally. • Row 7shows total number of readmissions. • Row 10shows number of readmissions that returned to the discharging facility • Row 13shows the number of readmissions that occurred at another facility. • Rows 16 and 17 provide additional detail about the readmissions to another facility by showing whether they were readmitted to another IPF or to an acute care hospital.

  37. Worksheet 4 (continued) Figure 4. Example of Worksheet 4, Table 7 • Table 7 (Figure 4)shows beneficiary-level data. • Rows 24 and 27show the number of eligible index admissions and readmissions, respectively. • Rows 25 and 28: number of beneficiaries with an eligible index admission or readmission, respectively. In the example, there are fewer beneficiaries than eligible index admissions or readmissions because beneficiaries can have multiple eligible index admissions during the measurement period. • The counts and percentages of beneficiaries with only one readmission during the measurement period are provided in Rows 30 and 31. • The counts and percentages of beneficiaries with two or more readmissions are provided in Rows 33 and 34.

  38. Worksheet 4 (continued) Figure 5. Example of Worksheet 4, Table s 8 and 9 • Tables 8 and 9 (Figure 5): the top ten CCS principal discharge diagnoses for eligible index admissions from your facility and nationwide. • The counts and percentages of index admissions are displayed in columns B and C for each CCS principal discharge diagnosis. • The percent of index admissions followed by a readmission within 30-days for each CCS principal discharge diagnosis is Measure Dry Run User Guide Inpatient Psychiatric Facility Quality Reporting Program Page 15 of 18) provided in column D.

  39. Worksheet 4 (continued) Figure 5. Example of Worksheet 4, Table s 8 and 9 • The percent of index admissions followed by a readmission within 30-days with the same CCS diagnosis as the index admission is provided in column E. • In the example, 31.8% of the index admissions have a principal discharge diagnosis of CCS 659.2 Psychosis. Of those index admissions for psychosis, 16.5% are followed by an unplanned readmission within 30-days of discharge, and 3.5% are followed by an unplanned readmission with a principal diagnosis of CCS 659.2 Psychosis.

  40. Worksheet 4 (continued) Figure 6. Example of Worksheet 4, Tables 10-11 • Tables 10 and 11 (Figure 6) show the top ten CCS principal discharge diagnoses for readmissions following discharges from your facility and following discharges nationwide.

  41. Worksheet 4 (continued) Figure 6. Example of Worksheet 4, Tables 10-11 • Example: a higher percentage of readmissions following discharge from the facility were related to psychosis than readmissions nationwide. When considered with the information from Tables 8 and 9, this could be due to the fact that the facility treats a higher percentage of patients with psychosis than are treated by IPFs nationally.

  42. Worksheet 5: Risk Factor Distribution Figure 7. Example of Worksheet 5, Table 12 • Worksheet 5 (Figure 7) contains Table 12, which shows a comparison of facility-level risk factor prevalence compared to national risk factor prevalence. • Patient risk factor categories include:gender, age, principal discharge diagnosis of the index admission, comorbidities, and other psychiatric-specific risk factors. • Example:the facility has a higher percentage of index admissions for patients between the ages of 18-34 than the national measure population. The facility does not have any qualifying admissions for patients with comorbid developmental disorders or dementia during the measurement period as indicated by “NQ” in the facility discharges column.

  43. Worksheet 6: Discharge-Level Data Table E. Data Description for Worksheet 6 • Worksheet 6 contains Table 12, which lists all eligible index admissions from your facility during the measurement period. • These index admissions constitute your measure population. • Descriptions of the data elements in Worksheet 6 are provided in Table E.

  44. RESOURCES • Questions regarding the IPF Readmission measure IPF-Specific Report can be emailed to: PQM@hsag.com • General questions about the IPFQR Program may be directed to the IPFQR Program Support Contractor by email at: IPFQualityReporting@area-m.hcqis.org or by calling (866) 800-8765, Monday-Friday, 8 am to 8 pm ET

  45. Improving Care Transitions • Using data to identify trends • Diagnoses • Risk Factors • Readmission facilities • Identifying trends can help improve the focus of your facility’s care transition processes

  46. Melanie Akin, EDS CRC Technical Advisor, Behavioral Health 678-527-3638 Melanie.akin@alliantquality.org Contact: Sources: Measure Information and User Guide for the IPF-Specific Report : 30-Day All-Cause Unplanned Readmission Following Psychiatric Hospitalization in an Inpatient Psychiatric Facility and Thirty-Day All-Cause Unplanned Readmission following Psychiatric Hospitalization in an Inpatient Psychiatric Facility Measure Version 1.1

  47. This material was prepared by GMCF, for Alliant Quality, the Medicare Quality Innovation Network – Quality Improvement Organization for Georgia and North Carolina, 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. 11SOW-GMCFQIN-G1-18-08

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