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

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1 Medicare Fee-For-Service (FFS) Hospital Readmissions: Q Q State of Florida Data Dictionary Provided on Page A Please contact Peggy Loesch via at Peggy.Loesch@HCQIS.org or by phone at for additional information

2 Overview Table 1: 30-Day All-Cause Readmission Rates Q Q Florida Baseline (CY 2013) Current Year 1 Q3 13 Q4 13 Q1 14 Q2 14 Goal 18.3% 18.5% 18.9% 18.0% 18.7% 16,851/91,968 3,965/21,390 4,270/22,625 4,341/24,115 4,369/23, % 19.8% 19.3% 18.8% 19.5% 143,943/752,612 34,396/173,856 35,544/184,227 38,165/202,670 36,869/189,007 Nation % RIR to Date Table 5: All-Cause Average Readmissions Rates by Region Region Average Rate Region % 18.5% Region % Region % Region % Region % Region % Region % Table 2: Number of Emergency Department (ED) Visits Q Q Q Q Q Q ,578 23,436 23,445 22,852 Florida 180, , , ,953 Table 3: Number of Observation Stays Q Q Q Q Q Q ,640 4,990 4,722 4,117 Florida 36,734 37,897 38,823 35,359 Table 4: Physician Follow-up Visits from Patients Discharged from Hospital Directly to Home Q Q Discharges to Home Total Follow-up in 30 Days % Follow-up Readmitted Count Follow-up Count % with Follow-up Days Count % No 28,529 21, % 01 to 14 16, % 34,271 24, % 15 to 30 4, % Yes 5,742 2, % 01 to 14 2, % 15 to % 1 Data Source: ICPC Quarterly Scorecard (January 1, 2013 through December 31, 2013). 2 These data will differ from subsequent data included in Table 6, as some data are excluded from this calculation. Please refer to the appendix for additional information on the methodology. March 2015 Page 1

3 Encounters by Millions Encounters by Thousands Figure 1: Florida and National Outpatient ED Visits, Observation Stays, and Inpatient Admissions 3, Florida ED Visits Florida Observation Stays Florida Admissions Q Q Q Q Q Q Q Q Q Q Q Q Q National ED Visits National Observation Stays National Admissions 2 0 Q Q Q Q Q Q Q Q Q Q Q Q ED visits and observations stays resulting in an inpatient stay are not included in this calculation. 4 National data are unavailable for Q March 2015 Page 2

4 All-Cause Readmission Rate Table 6: Discharge Distribution after Inpatient Hospitalization for All Causes Q Q Group Florida Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0 3 Days 4 7 Days 8 14 Days Days Days N % N % N % N % N % Home 17.0% 44,453 7,553 5, % 1, % 1, % 1, % 1, % 1, % 1, % SNF 21.6% 18,193 3,921 3, % % % % 1, % % % HHA 20.8% 17,970 3,731 3, % % % % % % % Hospice 1.8% 3, % % % % % % % Other 23.6% 7,093 1,673 1, % % % % % % % Total 18.5% 91,472 16,945 12, % 4, % 3, % 3, % 4, % 3, % 3, % Home 17.8% 345,669 61,699 45, % 16, % 10, % 11, % 15, % 11, % 12, % SNF 22.4% 160,040 35,811 27, % 8, % 5, % 6, % 9, % 7, % 7, % HHA 21.2% 150,438 31,861 25, % 6, % 5, % 6, % 8, % 5, % 6, % Hospice 2.6% 28, % % % % % % % Other 22.9% 64,822 14,842 9, % 5, % 3, % 2, % 3, % 2, % 2, % Total 19.3% 749, , , % 37, % 25, % 27, % 36, % 27, % 28, % Figure 2: 30-Day All-Cause Readmission Rates 5 25% 20% 15% 10% 5% 0% Region State Nation Q Q Q Q Q Q Q Q Q Q Q Q Q National data are obtained from the ICPC Quarterly Scorecard (January 1, 2013 through December 31, 2013). March 2015 Page 3

5 AMI Readmission Rate Table 7: Discharge Distribution after Inpatient Hospitalization for Acute Myocardial Infarction (AMI) Q Q Group Florida Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0 3 Days 4 7 Days 8 14 Days Days Days N % N % N % N % N % Home 16.6% 1, % % % % % % % SNF 29.6% % % % % % % % HHA 29.5% % % % % % % % Hospice 0.9% % % 0 0.0% 0 0.0% 0 0.0% 0 0.0% % Other 36.7% % % % 2 3.7% % 4 7.4% % Total 21.2% 2, % % % % % % % Home 15.2% 8,357 1, % % % % % % % SNF 29.0% 2, % % % % % % % HHA 25.7% 2, % % % % % % % Hospice 1.8% % % % 1 7.1% % 1 7.1% % Other 30.8% 1, % % % % % % % Total 20.0% 15,908 3, % % % % % % % Figure 3: 30-Day AMI Readmission Rates 6 25% <<figure3>> Region State Nation 20% 15% 10% 5% 0% Q Q Q Q Q Q Q Q Q Q Q Q Q National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are from July 1, 2009 through June 30, March 2015 Page 4

6 HF Readmission Rate Table 8: Discharge Distribution after Inpatient Hospitalization for Heart Failure (HF) Q Q Group Florida Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0 3 Days 4 7 Days 8 14 Days Days Days N % N % N % N % N % Home 25.0% 2, % % % % % % % SNF 29.4% % % % % % % % HHA 31.5% 1, % % % % % % % Hospice 0.3% % 0 0.0% 0 0.0% 0 0.0% % 0 0.0% 0 0.0% Other 29.2% % % % % % % % Total 26.1% 5,095 1,330 1, % % % % % % % Home 24.6% 15,734 3,873 3, % % % % % % % SNF 31.5% 7,598 2,393 1, % % % % % % % HHA 28.7% 10,111 2,903 2, % % % % % % % Hospice 2.8% 2, % % % % % % % Other 31.5% 2, % % % % % % % Total 26.4% 38,087 10,036 7, % 2, % 1, % 1, % 2, % 2, % 2, % Figure 4: 30-Day HF Readmission Rates 7 <<figure4>> 30% Region State Nation 20% 10% 0% Q Q Q Q Q Q Q Q Q Q Q Q Q National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are from July 1, 2009 through June 30, March 2015 Page 5

7 PNE Readmission Rate Table 9: Discharge Distribution after Inpatient Hospitalization for Pneumonia (PNE) Q Q Group Florida Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0 3 Days 4 7 Days 8 14 Days Days Days N % N % N % N % N % Home 16.4% 1, % % % % % % % SNF 25.1% % % % % % % % HHA 25.8% % % % % % % % Hospice 1.5% % % 0 0.0% 0 0.0% % 0 0.0% % Other 23.5% % % % % % % % Total 19.3% 3, % % % % % % % Home 15.6% 12,020 1,874 1, % % % % % % % SNF 24.7% 5,883 1,452 1, % % % % % % % HHA 22.6% 5,415 1,225 1, % % % % % % % Hospice 3.2% 1, % % % % % % % Other 22.2% 1, % % % % % % % Total 18.9% 26,657 5,031 3, % 1, % % % 1, % % 1, % Figure 5: 30-Day PNE Readmission Rates 8 25% Region State Nation 20% 15% 10% 5% 0% Q Q Q Q Q Q Q Q Q Q Q Q Q National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are from July 1, 2009 through June 30, March 2015 Page 6

8 COPD Readmission Rate Table 10: Discharge Distribution after Inpatient Hospitalization for Chronic Obstructive Pulmonary Disease (COPD) Q Q Group Florida Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0 3 Days 4 7 Days 8 14 Days Days Days N % N % N % N % N % Home 19.9% 2, % % % % % % % SNF 25.0% % % % % % % % HHA 28.9% % % % % % % % Hospice 2.3% % 0 0.0% 0 0.0% 0 0.0% % % % Other 24.7% % % % % % % % Total 22.0% 4, % % % % % % % Home 20.6% 18,023 3,704 3, % % % % % % % SNF 27.7% 4,663 1,292 1, % % % % % % % HHA 26.7% 7,007 1,873 1, % % % % % % % Hospice 3.6% % % % % % % % Other 27.7% 2, % % % % % % % Total 22.9% 32,760 7,504 6, % 1, % 1, % 1, % 1, % 1, % 1, % Figure 6: 30-Day COPD Readmission Rates 9 <<figure6>> 30% Region State 20% 10% 0% Q Q Q Q Q Q Q Q Q Q Q Q Q National COPD data are unavailable on the Hospital Compare website. March 2015 Page 7

9 TKA/THA Readmission Rate Table 11: Discharge Distribution after Inpatient Hospitalization for Total Hip/Knee Replacement (THA/TKA) Q Q Group Florida Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0 3 Days 4 7 Days 8 14 Days Days Days N % N % N % N % N % Home 3.9% % % % % % 0 0.0% 0 0.0% SNF 6.7% 1, % % % % % % % HHA 3.9% 1, % % % % % % % Hospice 0.0% % 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other 10.1% % 1 6.3% % 1 6.3% % % % Total 5.3% 3, % % % % % % % Home 4.0% 1, % % % % % % % SNF 6.7% 10, % % % % % % % HHA 4.1% 13, % % % % % % % Hospice 0.0% % 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other 8.7% 1, % % % % % % % Total 5.4% 27,550 1,486 1, % % % % % % % Figure 7: 30-Day THA/TKA Readmission Rates 10 8% 6% 4% 2% Region State Nation 0% Q Q Q Q Q Q Q Q Q Q Q Q Q National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are from July 1, 2009 through June 30, March 2015 Page 8

10 Table 12: Top 10 Index Admission Diagnosis Related Groups (DRGs) for Q Q DRG 12 Code Description N % 470 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 3, % 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC 2, % 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 2, % 885 PSYCHOSES 1, % 292 HEART FAILURE & SHOCK W CC 1, % 291 HEART FAILURE & SHOCK W MCC 1, % 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC 1, % 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 1, % 191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC 1, % 683 RENAL FAILURE W CC 1, % Table 13: Top 10 Readmission DRGs for Q Q DRG Code Description N % 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC % 291 HEART FAILURE & SHOCK W MCC % 292 HEART FAILURE & SHOCK W CC % 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC % 885 PSYCHOSES % 683 RENAL FAILURE W CC % 682 RENAL FAILURE W MCC % 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC % 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC % 378 G.I. HEMORRHAGE W CC % 11 Hospitalizations with a DRG code of 000 are excluded from this calculation. 12 Hospitalizations with DRG code of 000 are excluded. 13 Ibid. March 2015 Page 9

11 Methodology and Data Source Information The dashboard provides information regarding your hospital 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. Rates are calculated using hospital inpatient claims for Medicare Fee-For-Service (FFS) beneficiaries. Data in this report are limited to Medicare FFS Part-A data for discharges from April 1, 2013, through March 31, Readmission rates in this report are not calculated using the 30-day risk standardized methodology for the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program or found on hospitalcompare.hhs.gov. Readmission rates are updated quarterly with the most current time period s data. The time periods illustrated in this document are examples only and may not reflect the most current data period. Pages 1 and 2 contain the following information. 1 Summary table 4 2 Emergency department (ED) visits and observation stays tables 5 3 Physician follow-up visits table Regional map Outpatient ED visits, observation stays, and inpatient admissions graphs Example Dashboard (Pages 1 and 2) The CSAT data file was used for this analysis. The CSAT data file is provided to HSAG by CMS. The CSAT data file includes Part A and Part B claims for FFS beneficiaries. Please note that the results obtained from CSAT may vary from your own hospital s results. March 2015 Page A

12 Example Outpatient ED Visits, Observation Stays, and Inpatient Admissions Dashboard 5 1 Summary Table The summary table contains your hospital s Baseline and Current 30-day readmission rates, including the numerator and denominator for each quarter. All rates are calculated from Medicare inpatient claims for FFS beneficiaries. See page E for measure definitions. The summary table also includes Baseline and Current rates for the region, state, and nation. Due to availability of the data, the national rates may be calculated from a different time period. 2 ED Visits and Observation Stays Tables The ED visits and observation stays tables provide the count of ED visits and observation stays, respectively, for each quarter in the current report period. These tables also include data for the region and state. ED visits and observation stays resulting in an inpatient stay are not included in the counts. 3 Physician Follow-Up Table For all-cause readmissions, Medicare FFS Part-B data were used to identify whether a beneficiary had a claim for a physician office visit in the 30 days post discharge or before readmission for beneficiaries discharged to home. Patients discharged to home with claim for a post-acute service (e.g., home health, skilled nursing) in the 30 days post discharge or before readmission are excluded. March 2015 Page B

13 4 Regional Map The state of Florida was divided into eight regions. The regions are based on the Area Agencies on Aging Office Planning and Service Areas (PSA), with some areas aggregated to make eight regions. Aggregate readmission rates are calculated for each region using the hospitals located in the region. The table shows regional readmission rates for each region. 5 Outpatient ED Visits, Observation Stays, and Inpatient Admissions The three graphs depict the volume of outpatient ED visits, observation stays, and inpatient admissions for your hospital, the state, and the nation. The purpose of each is to monitor acute care utilization at the hospital, state, and national levels. The counts are calculated for quarterly periods from Medicare acute care claims for FFS beneficiaries. Claims are classified based on hierarchy rules similar to Medicare bundled payment rules. Each encounter counts as only one of three types: (1) Inpatient admission, (2) Observation stay, or (3) ED visit. Therefore, ED visits and observation stays that result in an inpatient stay are counted as an inpatient stay. ED visits that result in an observation stay, but not an inpatient stay, are counted as an observation stay. Pages 3 through 8 provide the following data for all-cause and condition-specific 30-day readmissions: 6 Discharge distribution table 7 Line graph Example Dashboard (discharge distribution and line graph) 6 7 March 2015 Page C

14 6 Discharge Distribution Table The discharge distribution table shows the 30-day readmission rates by discharge setting, the proportion of readmissions that occurred back to your hospital or another hospital, and the number of days from discharge to readmission. Readmissions from home, skilled nursing facilities (SNFs), home health agencies (HHAs), and hospice are determined by the patient discharge status on the index hospitalization claim. All other discharge status codes are bucketed into the Other category. Results for the state and your hospital s region are provided for comparison. 7 Line graph The purpose of the readmission line graph is to track readmission rates over time. The Line Graph shows your hospital s improvement in relation to the region (purple line), state (green line), and the nation (orange line). Rates are calculated quarterly. March 2015 Page D

15 Example Dashboard (Top 10 Diagnosis Related Groups) 8 8 Top 10 Diagnosis Related Groups (DRGs) at Admission and Readmission Tables 12 and 13 on page 9 depict the 10 most common DRGs associated with all discharges and readmissions for the time period. Hospitalizations with a DRG code of 000 are excluded from this calculation. All-Cause 30-Day Readmission Rates Measure Definitions All-cause readmission rates are calculated as the percentage of hospital admissions that occurred within 30 days of an index admission for any condition. Each hospital admission within 30 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 hospital or is transferred to another hospital on the same day is excluded from your facility s calculation. Readmissions from home, SNFs, HHAs, and hospice are determined by the patient discharge status on the index hospitalization claim. March 2015 Page E

16 Condition-Specific 30-Day Readmission Rates When calculating condition-specific readmission rates, an admission is included if the principal diagnosis/procedure code for the admission specifies that disease (i.e., AMI, HF, PNE, COPD, and THA/TKA). Condition-specific readmissions include all-cause admissions that occur within 30 days of an index admission for the specific condition (e.g., a beneficiary with an index admission of AMI who is readmitted for a urinary tract infection [UTI] is considered an AMI readmission). Any beneficiary who dies in the hospital or is transferred to another hospital on the same day is excluded from your facility s calculation. The following table lists the codes used to identify the discharges for AMI, HF, PNE, COPD, and THA/TKA. Disease Diagnosis Codes AMI , , , , , , , , , , , , , , , , , , , HF , , , , , , , , , 428 PNE 480.0, 480.1, 480.2, 480.3, 480.8, 480.9, 481.0, 482.0, 482.1, 482.2, 482.3, , , , 482.4, , , , , , , , , 482.9, 483.0, 483.1, 483.8, 485.0, 486.0, 487.0, COPD , , 491.8, 491.9, 492.8, , , , 496, *, *, *, 799.1* Procedure Procedural Codes THA/TKA , * Principal diagnosis when combined with a secondary diagnosis of COPD (491.21, , , or ) ED Visits and Observation Stays The following table lists the codes used to identify ED visits and observation stays. Revenue Codes HCPCS ED Visits 0450, 0451, 0452, 0456, 0459, 0981 Observation Stays 0762, 0760 AND G If AMI is found to be the principal diagnosis for the first admission and the readmission has a primary diagnosis of 410.x2, the original discharge is not included in the admission count. 16 This only includes elective primary THA/TKA procedures. March 2015 Page F

17 Florida Counties by Region Region 1 Bay Gulf Liberty Taylor Calhoun Holmes Madison Wakulla Escambia Jackson Okaloosa Walton Franklin Jefferson Santa Rosa Washington Gadsden Leon Alachua Dixie Lafayette Putnam Bradford Gilchrist Lake Sumter Citrus Hamilton Levy Suwannee Columbia Hernando Marion Union Region 3 Baker Duval Nassau Volusia Clay Flagler Saint Johns Region 4 Brevard Osceola Seminole Orange Region 5 Indian River Okeechobee Saint Lucie Martin Palm Beach Region 6 Broward Miami-Dade Monroe Region 7 Charlotte De Soto Hendry Sarasota Collier Glades Lee Region 8 Hardee Hillsborough Pasco Polk Highlands Manatee Pinellas This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Florida, 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. FL-11SOW-C March 2015 Page G