Interpreting CMS Hospital Readmission Reports

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Franklin Walters
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1 Interpreting CMS Hospital Readmission Reports Welcome Slide 1 Hi. Good afternoon everybody. Thank you so much for coming and joining us today. I am looking at the Event Center now and seeing that we have over 109 participants currently and we re very pleased to have you all join with us today. Before I get started I d like to extend a huge thank you to our partners and peers in the Alabama, Indiana, Kentucky, Mississippi, and Tennessee Hospital Associations. Your support for this initiative and broadcasting of this webcast today was critical to our success and roll-out of what we hope will be some very beneficial information for all of the hospital providers who are interested in participating in working with us and to continue our work to reduce potential and unavoidable and unnecessary readmissions over the course of the next contract period. Slide 2 I am looking at the Event Center now and seeing that we have over 109 participants currently and we re very pleased to have you all join with us today. Before I get started I d like to extend a huge thank you to our partners and peers in the Alabama, Indiana, Kentucky, Mississippi, and Tennessee Hospital Associations. Your support for this initiative and broadcasting of this webcast today was critical to our success and roll-out of what we hope will be some very beneficial information for all of the hospital providers who are interested in participating in and working with us and to continue our work to reduce potential, avoidable and unnecessary readmissions over the course of the next contract period. Introduction Slide 3 Let me start quickly by introducing the atom Alliance to those of you who may not be familiar. The atom Alliance is a multi-state alliance of three organizations: Qsource, who functions as the boots-on-the-ground for Indiana, Kentucky, and Tennessee s Quality Improvement Organizations efforts; IQH, Information and Quality Healthcare, who is our partner and representative in Mississippi; and Alabama Quality Assurance Foundation, or AQAF, and Alabama represents our constituency in that state as a local resource and partner. Together, we formed what we have termed the atom Alliance, which represents our QIO contract for these five states. Slide 4 The work of readmissions started with Partnership for Patients, and under that work Hospital Engagement Networks, or HENs as they were known originally, and Quality Improvement

2 Organizations have worked together to decrease potentially avoidable and unnecessary readmissions. QIOs have worked with community support systems and stakeholders and representatives from the larger community health system to support hospital efforts while the Hospital Engagement Networks have been critical to engaging hospitals and also focusing on elements including discharge planning, follow-up, and critical other community-based service connections to the community. We realize that in order to do this, you need tools and resources to do this, and in order to help you better evaluate these opportunities to further reduce readmissions, we ve come together to present you with some readmission reports that we hope will provide those supports and opportunities. Slide 5 I d like to turn it over now to Melanie Fite. Melanie comes to us as our analytic support and programmer for this initiative. She has been working in the healthcare system for over 30 years as medical practice operations, compliance and HIPAA privacy and security. She has expertise including information systems, data analytics, report writing and presenting data results. Melanie also holds a master s degree in business administration. Thank you all again for your participation in today s meeting. We hope you find the information presented today of value. CMS Readmission Report Delivery Slide 6 First I m going to go over a couple of things about the report delivery. So, how do I know that I ve received the report? If you re a registered QualityNet user, you should receive the following notification. It will tell you what the name of the file is and where to log-in to receive the file. If you re not a registered QualityNet user, please see your QIO Liaison. Slide 7 This slide shows you how to download your reports via QualityNet. You go to the QualityNet website. Log-in. Click on Secure File Transfer. Locate your AutoRoute Inbox and click on it. The hospital report should be in the Inbox if your account was active at the time of the file upload. Highlight it and click Download, and you ll be able to save the file wherever you d like it to be saved. CMS Readmission Report Review Slide 8 In this presentation, I ll be going through the report interpretation in detail. But first I m going to give you the Objectives. During this webinar you will learn how to: Understand and interpret your CMS Readmissions Report; gain a better understanding and evaluate the complex nature of hospital readmissions; and review analysis of contributing factors from Medicare Part A claims. Just a few things about the report before I go over this first chart. This consolidated report contains information obtained from Medicare Part A claims. Monthly discharges are from your hospital, which is the index hospital. Readmission rate is calculated by using the total number of

3 readmissions from all facilities. Pages A -1 thru A-6 (which are the first 6 pages of the report) will reflect the monthly number of discharges and associated readmissions data for the past 12 months of data. Slide 9 Page A-1 reflects monthly discharges from your facility. Total readmission count is followed by readmissions to your facility in parenthesis. For example, in the red circle on the left, there are 353 all-cause discharges, 81 total readmissions, with 44 readmissions from the same hospital. Discharges by diagnosis are calculated using the patient s primary diagnosis code. We chose 6 primary diagnosis codes to analyze. They are: AMI (Acute Myocardial Infarction), HTF, which is Heart Failure, PNE, which is Pneumonia, VTE, which is Venous Thromboembolism, and COPD (Chronic Obstructive Pulmonary Disease). The primary diagnosis code analysis follows the same structure, the discharge, all readmissions/same hospital readmissions and the readmission rate. If you ll notice in the red circle on the right, there may some blanks in this table, as noted in the circle. This is not due to lack of data. This means that there were zero discharges for that primary discharge code, which is VTE in this example. Therefore zero readmissions and no readmission rate was able to be calculated. Slide 10 In the bar chart, readmissions to and from your facility are noted in blue. Readmissions to another facility associated with your discharges are noted in green. Your hospital s 30-Day all cause readmission rate for each month is ranked relative to all hospital providers in the state. Slide 11 The hospitals rank is determined by ordering facilities from lowest to highest 30-day readmission rates, and rank is established relative to the total number of providers in the state. In this case, there were 112 providers. The lower the 30-day readmission rate, the better the state rank is. This means that if you have a state rank of 1, you have the lowest 3-day all-cause readmission rate in the state. Slide 12 On pages A3 through A6, all cause and each of the 6 primary diagnoses readmission rates are plotted by month to show rates over time and to compare them with the statewide averages for the same time periods. Something I want to point out in the red circle, what I want to show you is that data points can fluctuate tremendously when the hospital has very small denominators, which are the discharges. For example, inside the red circle we see that month 10 has a 0% readmission rate. This could be two discharges and zero readmissions. In month 12, discharges could also be two and readmission is one, which gives your hospital a 50% readmission rate for that month. As you can see the readmission rate can jump from 0 to 50 percent.

4 Slide 13 Pages B1 through B6 contain the same analysis and are similar in all respects to the first six pages of the report; however, B1 through B6 reflect your hospital s QUARTERLY rather than monthly number of discharges and associated readmissions. The quarterly reports contains 3 years of data. Slide 14 The chart and graphs on Page C shows discharges, readmissions and 30-Day readmission rates for all cause and the selected 6 primary diagnoses as compared to the state-wide average. Slide 15 Page D represents your hospital s discharges by discharge destination. This is using Part A claims indicated discharge destination for the most recent quarter of data. % of Discharges is the percent of total discharges using the associated discharge code. Readmissions is the number of readmissions occurring among those discharged using the associated discharge code. % of Readmissions is the percent of total readmissions using the associated discharge code. Readmission rate is the percentage of readmissions in relation to the total number of discharges associated with the associated discharge code. Slide 16 On the second half of Page D, the frequency of beneficiaries with 30-Day readmissions reflects your hospital s count of readmissions categorized by beneficiary utilization. For example, in the red circle on the left, we can see that one beneficiary was readmitted seven times within 30 days. Bene % is the percentage of beneficiaries as a total of beneficiary count. The column titled Readm is the Beneficiary count times the readmission frequency. And, as you can see in the red circle on the right, this is just a graphed visualization of the one patient that was readmitted seven times. Slide 17 Page E represents a chart and corresponding graph depicting mortality rates over time compared to the statewide rates. Mortality rate is defined as deaths in the 30 days after admission date as the numerator and number of unique beneficiary discharges as the denominator. This is Medicare only data and the death rate will be higher. Hospitals should have a lower rate. The Quality Innovation Networks (the QINs) have access to every Medicare beneficiary s date of death through CMS, which gets the date from the death certificate. Hospitals usually don t have access to every Medicare beneficiary s date of death unless they follow them after discharge. Slide 18 This chart shows the average CMS reimbursement for all admissions and the select clinical conditions for primary diagnosis over time and the state-wide average, as well.

5 Interpreting the CMS Readmission Report Slide 19 So, how can this data be helpful to your hospital? Are there patterns in the data that might suggest opportunities to improve your hospital s identification of appropriate readmissions reduction efforts? For example, is your state rank significantly higher than the rest of the hospitals statewide? (Page A-2) Are there patterns of higher readmissions within a particular clinical condition that might warrant targeting a particular hospital unit for enhanced discharge planning? (Page A-1) For instance, if your COPD readmission rates, which are going to be higher than all-cause, but they re much higher than the state rate, this might be an opportunity to implement or develop an appropriate intervention. Are the results due primarily to larger than expected readmissions from nursing homes? (Page D) Are results due to a small number of beneficiaries that are frequent hospital utilizers? (Page D) After reviewing the data, you can conduct internal confirmatory analysis and develop appropriate interventions as needed. Slide 20 What data can atom provide that you don t have access to now? We can provide Readmissions data to other hospitals, state ranking by readmission rates, discharge to and readmissions from different discharge settings, and data that supports your efforts to better understand and evaluate the complex nature of hospital readmissions. Closing Thank you very much for joining us today and please remember that atom Alliance staff is here to help you. The recording and transcript will be posted to the atomalliance.org website, in the on-demand learning section. Our On-Demand Learning area on [the atom Alliance Website] allows you to participate in archived events when it is most convenient. We look forward to seeing you in other virtual places as well please connect with us on Facebook, Twitter, LinkedIn or Pinterest! Thank you again and have a wonderful afternoon.

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