Executive Summary MEDICARE FEE-FOR-SERVICE (FFS) HOSPITAL READMISSIONS: QUARTER 4 (Q4) 2012 Q STATE OF CALIFORNIA

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1 MEDICARE FEE-FOR-SERVICE (FFS) HOSPITAL READMISSIONS: QUARTER 4 (Q4) 2012 Q Executive Summary STATE OF CALIFORNIA The Centers for Medicare & Medicaid Services (CMS) has tasked Health Services Advisory of, Inc. (HSAG of ), with assisting communities, s, and post-acute providers with improving the quality of care for Medicare beneficiaries who transition among care settings. This document provides information regarding the state of s all-cause, acute myocardial infarction (AMI), heart failure (HF), pneumonia (PNE), chronic obstructive pulmonary disease (COPD), and total hip/knee replacement (THA/TKA) 30-day readmissions. Readmission results are limited to Medicare FFS Part-A data for discharges from October 1, 2012, through September 30, Readmissions were identified from October 1, 2012, through October 30, Readmission rates in this report are not calculated using the 30-day risk standardized methodology for the CMS Hospital Readmission Reduction Program or on compare.hhs.gov. Data are broken out into seven different sections: All-Cause s AMI s HF s PNE s COPD s THA/TKA s Emergency Department (ED) Visits and Observation Stays Details for All-Cause Readmissions: All-cause readmission rates are calculated as the percentage of admissions that occurred days of an index admission for any condition. Each admission 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 is excluded from the calculation. Details for Condition-Specific Readmissions: When calculating disease-specific readmission rates, an admission is included if the principal diagnosis code for the admission specifies that disease (i.e., AMI, HF, PNE, COPD, and THA/TKA readmission rates). Conditionspecific readmissions include all-cause admissions that occur days of an index admission for the specific condition (e.g., a beneficiary with an index admission of AMI and is readmitted for a urinary tract infection [UTI] is considered an AMI readmission). Any beneficiary who dies in the is excluded from the calculation. For questions on the results, please contact Chad Vargas at , cvargas@hsag.com or Michelle Pastrano at , mpastrano@hsag.com. 1 The ASAT data file was used for this analysis. The ASAT data file is provided to HSAG by CMS. The ASAT data file includes Part-A claims for Fee-for-Service (FFS) beneficiaries. Statewide Readmission Report 1

Region-Level Map The figure below displays the location of each region in the state of. The table below displays the average readmission rate for each region from the best rate to the worst rate.

2 Region-Level Map The figure below displays the location of each region in the state of. The table below displays the average readmission rate for each region from the best rate to the worst rate. In addition, a crosswalk of the counties located in each region has been provided. Region Avg Rate Region and County Crosswalk 8 7.8% Region Counties % Region 1 San Diego/Imperial % Region 2 Riverside/San Bernardino % Region 3 Orange 10 1 Region 4 Los Angeles/Antelope Valley % Region 5 Santa Barbara/Ventura % Region 6 San Luis Obispo % Region 7 Kern % Region 8 Inyo/Mono % Region 9 Madera/Fresno/Kings/Tulare % Region 10 Monterey/San Benito % Region 11 Stanislaus/Merced/Mariposa % Region 12 Santa Clara % Region 13 San Mateo/Santa Cruz % Region 14 San Francisco % Region 15 Solano/Contra Costa/Alameda % Region 16 San Joaquin/Amador/Calaveras/Tuolumne/Alpine % Region 17 Yolo/Sacramento/Nevada/Placer/El Dorado % Region 18 Sutter/Yuba/Sierra/Plumas/Tehama/Glenn/Colusa/Butte % Region 19 Marin/Napa/Sonoma/Lake/Mendocino/Humboldt/Del Norte Region 20 Siskiyou/Modoc/Trinity/Shasta/Lassen Statewide Readmission Report 2

3 All-Cause s Table 1 depicts the all-cause 30-day readmission rates by discharge setting for Q through Q for the state of. Table 1: All-Cause s Readmit Rate Home 368,292 63, % 46, % 17, % SNF 171,396 35, % 26, % 9, % HHA 125,239 24, % 19, % 5, % Hospice 16, % % % Other 54,508 11, % 6, % 4, % All 735, , % 98, % 36, % Table 2 depicts the number of days from discharge to readmission for each discharge setting for the state of. Table 2: from Discharge to Readmission Readmissions N % N % N % N % N % Home 63,098 10, % 12, % 15, % 12, % 12, % SNF 35,993 5, % 6, % 9, % 7, % 7, % HHA 24,458 4, % 4, % 6, % 4, % 4, % Hospice % % % % % Other 11,045 2, % 1, % 2, % 2, % 2, % All 135,132 22, % 25, % 33, , % 26, % Statewide Readmission Report 3

4 Table 3 provides a comparison of the age breakouts for those cases that were readmitted for all causes versus those that were not readmitted for the state of. 2 Table 3: Age Breakout by Readmission Category Age Cases Non- Cases tal % of tal N % N % N % < % % 1, % 1, % , % 7, % 10, % , % 14, % 19, % , % 34, % 45, % , % 59, % 76, % , % 184, % 221, % , % 168, % 204, % , % 129, % 155, % tal 135, , , % Table 4 provides a comparison of the all-cause 30-day readmission rates by gender for Q through Q for the state of. Table 4: Gender Breakout by Readmission Category % of tal Gender Cases Non- Cases tal N % N % N % Female 67, % 326, % 393, % Male 67, % 274, % 341, % tal 135, , , % 2 The counts in the following tables may not equal the total readmission and discharge counts, due to the receipt of incomplete data in some claims. Statewide Readmission Report 4

5 Table 5 depicts the all-cause 30-day readmission rates by race for Q through Q for the state of. 3,4 Table 5: All-Cause s by Race/Ethnicity Race Cases Non- Cases tal % of tal Categories N % N % N % White 91, % 437, % 529, % Black 15, % 50, % 66, % Asian 9, % 41, % 50, % Hispanic 11, % 44, % 56, % Native American % 3, % 4, % Other 5, % 24, % 29, % tal 135, , , % Table 6 depicts the all-cause 30-day readmission rates by discharge setting year for calendar year (CY) 2010 (i.e., baseline period), CY 2011, and CY 2012 for the state of. CY 2010 CY 2011 CY 2012 Table 6: All-Cause s by Year Readmit Rate Home 410,034 72, % 53, % 19, % SNF 172,447 39, % 29, % 10, % HHA 120,117 24, % 19, % 5, % Hospice 14, % % % Other 51,240 10, % 6, % 4, % All 768, , % 108, % 39, % Home 402,804 70, % 51, % 18, % SNF 175,361 40, % 29, % 10, % HHA 120,829 25, % 19, % 5, % Hospice 15, % % % Other 53,248 11, % 6, % 4, % All 768, , % 108, % 39, % Home 389,236 67, % 49, % 18, % SNF 173,939 38, % 28, % 10, % HHA 123,159 24, % 19, % 5, % Hospice 16, % % % Other 53,577 10, % 6, % 4, % All 756, , % 103, % 38, % 3 Caution should be exercised when evaluating readmission rates for races with a low number of discharges/readmissions. 4 The counts in the Race/Ethnicity table may not equal the total readmission and discharge counts, due to the receipt of incomplete data in some claims. Statewide Readmission Report 5

6 Figure 1 displays the all-cause 30-day readmission rates for home, skilled nursing facility (SNF), home health agency (HHA), hospice, other, and all settings for CY 2010 (i.e., baseline period), CY 2011, and CY 2012 for the state of. 3 Figure 1: s by Discharge CY 2010 CY 2011 CY 2012 Time Period Home Home Health Agency Other Skilled Nursing Facility Hospice All Table 7 depicts the all-cause 30-day readmissions and admissions per 1,000 beneficiaries for CY 2010 (i.e., baseline period), CY 2011, and CY 2012 for the state of. Table 7: All-Cause s per 1,000 Beneficiaries by Year CY 2010 CY 2011 CY 2012 FFS Beneficiaries All-Cause Readmissions Readmissions per 1,000 Beneficiaries All-Cause Admissions Admissions per 1,000 Beneficiaries 3,066, , , ,130, , , ,246, , , Statewide Readmission Report 6

7 Table 8 depicts the all-cause 30-day readmission rates for patients discharged to home for Q through Q for the state of. Home Table 8: All-Cause s by Quarter for Patients to Home Quarter Readmit Rate Q ,473 16, % 11, % 4, % Q ,919 16, % 12, % 4, % Q ,371 15, % 11, % 4, % Q ,529 14, % 10, % 3, % All 368,292 63, % 46, % 17, % Figure 2 displays the all-cause 30-day readmission rates for patients discharged to home for Q through Q for the state of. The readmission rate for each quarter is displayed above the bar. Figure 2: by Quarter for Patients to Home % 17.3% 16.9% 16.8% 1 Q Q Q Q Statewide Readmission Report 7

8 Table 9 depicts the all-cause 30-day readmission rates for patients discharged to home for each month in Q through Q for the state of. Home Table 9: All-Cause s by Month for Patients to Home Month Readmit Rate Readmits to October ,394 5, % 4, % 1, % November ,696 5, % 3, % 1, % December ,383 5, % 4, % 1, % January ,080 6, % 4, % 1, % February ,038 5, % 3, % 1, % March ,801 5, % 4, % 1, % April ,332 5, % 3, % 1, % May ,822 5, % 3, % 1, % June ,217 4, % 3, % 1, % July ,433 4, % 3, % 1, % August ,652 5, % 3, % 1, % September ,444 4, % 3, % 1, % All 368,292 63, % 46, % 17, % Figure 3 displays the all-cause 30-day readmission rates for patients discharged to home for each month in Q through Q for the state of. The readmission rate for each month is displayed above the bar. Figure 3: by Month for Patients to Home % 17.7% 17.6% 17.1% 17.2% 17.1% 17.2% 16.7% 16.9%16.9% 17.0% 16.4% Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Statewide Readmission Report 8

9 Table 10 depicts the all-cause 30-day readmission rates for patients discharged to a SNF for Q through Q for the state of. SNF Table 10: All-Cause s by Quarter for Patients to SNF Quarter Readmit Rate Q ,467 9, % 6, % 2, % Q ,694 10, % 7, % 2, % Q ,261 8, % 6, % 2, % Q ,974 8, , % 2, % All 171,396 35, % 26, % 9, % Figure 4 displays the all-cause 30-day readmission rates for patients discharged to a SNF for Q through Q for the state of. The readmission rate for each quarter is displayed above the bar. Figure 4: by Quarter for Patients to a SNF % 21.8% 20.6% 2 Q Q Q Q Statewide Readmission Report 9

10 Table 11 depicts the all-cause 30-day readmission rates for patients discharged to a SNF for each month in Q through Q for the state of. SNF Table 11: All-Cause s by Month for Patients to SNF Month Readmit Rate Readmits to October ,457 3, % 2, % % November ,905 2, % 2, % % December ,105 3, % 2, % % January ,295 3, % 2, % 1, % February ,071 3, % 2, % % March ,328 3, % 2, % % April ,969 2, % 2, % % May ,077 2, % 2, % % June ,215 2, % 1, % % July ,944 2, % 2, % % August ,953 2, % 2, % % September ,077 2, % 1, % % All 171,396 35, % 26, % 9, % Figure 5 displays the all-cause 30-day readmission rates for patients discharged to a SNF for each month in Q through Q for the state of. The readmission rate for each month is displayed above the bar. Figure 5: by Month for Patients to a SNF % 21.6%21.5% 21.5% 21.6% 20.8% 20.8% 20.4%20.4%20.4% 20.3% 19.4% Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Statewide Readmission Report 10

11 Table 12 depicts the all-cause 30-day readmission rates for patients discharged to a HHA for Q through Q for the state of. HHA Table 12: All-Cause s by Quarter for Patients to HHA Quarter Readmit Rate Q ,942 6, % 4, % 1, % Q ,514 6, % 5, % 1, % Q ,456 5, % 4, % 1, % Q ,327 6, % 4, % 1, % All 125,239 24, % 19, % 5, % Figure 6 displays the all-cause 30-day readmission rates for patients discharged to a HHA for Q through Q for the state of. The readmission rate for each quarter is displayed above the bar. Figure 6: by Quarter for Patients to a HHA % 19.3% 19.1% 19.8% 1 Q Q Q Q Statewide Readmission Report 11

12 Table 13 depicts the all-cause 30-day readmission rates for patients discharged to a HHA for each month in Q through Q for the state of. HHA Table 13: All-Cause s by Month for Patients to HHA Month Readmit Rate Readmits to October ,486 2, % 1, % % November ,110 1, % 1, % % December ,346 2, % 1, % % January ,759 2, % 1, % % February ,857 2, % 1, % % March ,898 2, % 1, % % April ,339 1, % 1, % % May ,385 2, % 1, % % June ,732 1, % 1, % % July ,172 2, % 1, % % August ,454 2, % 1, % % September ,701 1, % 1, % % All 125,239 24, % 19, % 5, % Figure 7 displays the all-cause 30-day readmission rates for patients discharged to a HHA for each month in Q through Q for the state of. The readmission rate for each month is displayed above the bar. Figure 7: by Month for Patients to a HHA % 20.3% 19.4% 19.8% 19.5% 19.5% 19.6% 19.4% 19.9% 18.9% 19.3% 18.4% Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Statewide Readmission Report 12

13 Table 14 depicts the all-cause 30-day readmission rates for patients discharged to all settings for Q through Q for the state of. All s Table 14: All-Cause s by Quarter for Patients to All s Quarter Readmit Rate Q ,657 34, % 25, % 9, % Q ,349 36, % 26, % 10, % Q ,271 32, % 23, % 8, % Q ,403 31, % 22, % 8, % All 735, , % 98, % 36, % Figure 8 displays the all-cause 30-day readmission rates for patients discharged to all settings for Q through Q for the state of. The readmission rate for each quarter is displayed above the bar. Figure 8: by Quarter for Patients to All s % 18.6% 18.1% 18.0% 1 Q Q Q Q Statewide Readmission Report 13

14 Table 15 depicts the all-cause 30-day readmission rates for patients discharged to all settings for each month in Q through Q for the state of. All s Table 15: All-Cause s by Month for Patients to All s Month Readmit Rate Readmits to October ,374 11, % 8, % 3, % November ,517 11, % 8, % 3, % December ,766 11, % 8, % 3, % January ,943 13, % 9, % 3, % February ,108 11, % 8, % 3, % March ,298 11, % 8, % 3, % April ,509 11, % 7, % 3, % May ,127 11, % 8, % 3, % June ,635 10, % 7, % 2, % July ,153 10, % 7, % 2, % August ,709 10, % 7, % 2, % September ,541 9, % 7, % 2, % All 735, , % 98, % 36, % Figure 9 displays the all-cause 30-day readmission rates for patients discharged to all settings for each month in Q through Q for the state of. The readmission rate for each month is displayed above the bar. Figure 9: by Month for Patients to All s %18.6% 18.9% 19.0% 18.5% 18.2% 18.2% 18.0%18.1%18.2% 18.2% 17.5% 1 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Statewide Readmission Report 14

15 Figure 10 displays the all-cause 30-day readmission rates for the state of and the nation for CY 2010 (i.e., baseline period), CY 2011, CY 2012, Q1 2013, Q2 2013, and Q Figure 10: All-Cause s 1 CY 2010 CY 2011 CY 2012 Q Q Q Time Period State Rate National Rate All-Cause Mortality Rates Table 16 depicts the all-cause 30-day mortality rates from admission for Q through Q for the state of. 5 Table 16: All-Cause Mortality Rates Quarter Statewide Q % Q % Q % Q % 5 The 30-day mortality rates are not risk adjusted. Statewide Readmission Report 15

16 AMI s Table 17 depicts the discharge setting after inpatient ization for AMI and 30-day readmission rates by discharge setting for Q through Q for the state of. Table 17: AMI s Readmit Rate Home 8,874 1, % 1, % % SNF 2, % % % HHA 2, % % % Hospice % % % Other 1, % % % All 15,118 2, % 2, % % Table 18 depicts the number of days from discharge to readmission by discharge setting for AMI for the state of. Table 18: from AMI Discharge to Readmission Readmissions N % N % N % N % N % Home 1, % % % % % SNF % % % % % HHA % % % % % Hospice % % % 1 7.1% Other % % % % % All 2, % % % % % Statewide Readmission Report 16

17 Figure 11 displays the AMI 30-day readmission rates for the state of and the nation for CY 2010 (i.e., baseline period), CY 2011, CY 2012, Q1 2013, Q2 2013, and Q Figure 11: AMI s 2 1 CY 2010 CY 2011 CY 2012 Q Q Q Time Period State Rate National Rate AMI Mortality Rates Table 19 depicts the AMI 30-day mortality rates from admission for Q through Q for the state of. 6 Table 19: AMI Mortality Rates Quarter Statewide Q % Q % Q % Q % 6 The 30-day mortality rates are not risk adjusted. Statewide Readmission Report 17

18 HF s Table 20 depicts the discharge setting after inpatient ization for HF and 30-day readmission rates by discharge setting for Q through Q for the state of. Table 20: HF s Readmit Rate Home 17,965 4, % 3, % 1, % SNF 6,798 1, % 1, % % HHA 7,678 2, % 1, % % Hospice 1, % % % Other 1, % % % All 35,338 9, % 6, % 2, % Table 21 depicts the number of days from discharge to readmission by discharge setting for HF for the state of. Table 21: from HF Discharge to Readmission Readmissions N % N % N % N % N % Home 4, % % 1, % % % SNF 1, % % % % % HHA 2, % % % % % Hospice % % % % % Other % % % % % All 9,075 1, % 1, % 2, % 1, % 1, % Statewide Readmission Report 18

19 Figure 12 displays the HF 30-day readmission rates for the state of and the nation for CY 2010 (i.e., baseline period), CY 2011, CY 2012, Q1 2013, Q2 2013, and Q Figure 12: HF s CY 2010 CY 2011 CY 2012 Q Q Q Time Period State Rate National Rate HF Mortality Rates Table 22 depicts the HF 30-day mortality rates from admission for Q through Q for the state of. 7 Table 22: HF Mortality Rates Quarter Statewide Q % Q % Q % Q % 7 The 30-day mortality rates are not risk adjusted. Statewide Readmission Report 19

20 PNE s Table 23 depicts the PNE 30-day readmission rates by discharge setting for Q through Q for the state of. Table 23: PNE s Readmit Rate Home 13,672 2, % 1, % % SNF 7,106 1, % 1, % % HHA 5,009 1, % % % Hospice % % 1 9.1% Other 1, % % % All 28,401 5, % 3, % 1, % Table 24 depicts the number of days from discharge to readmission by discharge setting for PNE for the state of. Table 24: from PNE Discharge to Readmission Readmissions N % N % N % N % N % Home 2, % % % % % SNF 1, % % % % % HHA 1, % % % % % Hospice % % % 1 9.1% % Other % % % % % All 5, % % 1, % 1, % 1, % Statewide Readmission Report 20

21 Figure 13 displays the PNE 30-day readmission rates for the state of and the nation for CY 2010 (i.e., baseline period), CY 2011, CY 2012, Q1 2013, Q2 2013, and Q Figure 13: PNE s CY 2010 CY 2011 CY 2012 Q Q Q Time Period State Rate National Rate PNE Mortality Rates Table 25 depicts the PNE 30-day mortality rates from admission for Q through Q for the state of. 8 Table 25: PNE Mortality Rates Quarter Statewide Q % Q % Q % Q % 8 The 30-day mortality rates are not risk adjusted. Statewide Readmission Report 21

22 COPD s Table 26 depicts the state of s COPD 30-day readmission rates by discharge setting for Q through Q Table 26: COPD s Readmit Rate Home 10,504 2, % 1, % % SNF 3, % % % HHA 3, % % % Hospice % Other 1, % % % All 18,419 4, % 3, % % Table 27 depicts the number of days from discharge to readmission by discharge setting for COPD for the state of. Table 27: from COPD Discharge to Readmission Readmissions N % N % N % N % N % Home 2, % % % % % SNF % % % % HHA % % % % % Hospice Other % % % % % All 4, % % 1, % % Statewide Readmission Report 22

23 Figure 14 displays the COPD 30-day readmission rates for the state of and the nation for CY 2010 (i.e., baseline period), CY 2011, CY 2012, Q1 2013, Q2 2013, and Q Figure 14: COPD s 2 1 CY 2010 CY 2011 CY 2012 Q Q Q Time Period State Rate National Rate COPD Mortality Rates Table 28 depicts the COPD 30-day mortality rates from admission for Q through Q for the state of. 9 Table 28: COPD Mortality Rates Quarter Statewide Q % Q % Q % Q % 9 The 30-day mortality rates are not risk adjusted. Statewide Readmission Report 23

24 THA/TKA s Table 29 depicts the THA/TKA 30-day readmission rates by discharge setting for Q through Q for the state of. Table 29: THA/TKA s Readmit Rate Home 5, % % % SNF 8, % % % HHA 13, % % % Hospice Other 1, % % % All 29,401 1, % % % Table 30 depicts the number of days from discharge to readmission by discharge setting for THA/TKA for the state of. Table 30: from THA/TKA Discharge to Readmission Readmissions N % N % N % N % N % Home % % % % % SNF % % % HHA % % % % % Hospice Other % % % % % All 1, % % % % % Statewide Readmission Report 24

25 Figure 15 displays the THA/TKA 30-day readmission rates for the state of for CY 2010 (i.e., baseline period), CY 2011, CY 2012, Q1 2013, Q2 2013, and Q Figure 15: THA/TKA s CY 2010 CY 2011 CY 2012 Q Q Q Time Period State Rate THA/TKA Mortality Rates Table 31 depicts the THA/TKA 30-day mortality rates from admission for Q through Q for the state of. 10 Table 31: THA/TKA Mortality Rates Quarter Statewide Q % Q % Q % Q % 10 The 30-day mortality rates are not risk adjusted. Statewide Readmission Report 25

26 Emergency Department (ED) Visits and Observation Stays Table 32 depicts the number of ED visits for Q through Q for the state of. 11 Table 32: ED Visits Quarter Statewide Q ,689 Q ,888 Q ,772 Q ,963 Table 33 depicts the number of observation stays for Q through Q for the state of. 12 Table 33: Observation Stays Quarter Statewide Q ,246 Q ,783 Q ,079 Q , Note: ED visits resulting in an inpatient stay are not included in this number. 12 Note: Observation stays resulting in an inpatient stay are not included in this number. Statewide Readmission Report 26

27 Appendix s Included in the Other Category The Other category in the tables throughout the report includes discharges to the following settings: Psychiatric Long-term care Rehabilitation facility Federal government-operated healthcare facility Intermediate care facility Short-term general Critical access Left against medical advice Other institutions Diagnosis Code List for Disease-Specific The following table lists the diagnosis codes used to identify the discharges for AMI, HF, PNE, and COPD. Disease AMI Diagnosis Codes , , , , , , , , , , , , , , , , , , , HF , , , , , , , , , 428 PNE 480.0, 480.1, 480.2, 480.3, 480.8, 480.9, 482.0, 482.1, 482.2, 482.9, 483.0, 483.1, 483.8, 487.0, 481, 485, 486, , , , , , , , , , , , COPD 491, 492, 496 Procedural Code List for Disease-Specific The following table lists the procedural codes used to identify the discharges for THA/TKA. Procedure Procedural Codes THA/TKA 81.51, This material was prepared by Health Services Advisory of, Inc., 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. CA-10SOW A-1

Medicare Fee-For-Service (FFS) Hospital Readmissions: Q Q2 2014

Medicare Fee-For-Service (FFS) Hospital Readmissions: Q3 2013 Q2 2014 State of Florida Data Dictionary Provided on Page A Please contact Peggy Loesch via email at Peggy.Loesch@HCQIS.org or by phone at