Medicare Fee-For-Service (FFS) Hospital Readmissions: Q Q1 2017

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1 Medicare Fee-For-Service (FFS) Hospital Readmissions: Q Q State of Please contact Rosalie McGinnis via at or by phone at for additional information. This material was prepared by Health Services Advisory Group, 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. OH-11SOW-C

2 Overview Table 1: 30-Day All-Cause Readmission Rates Q Q Baseline Current (CY 2013) Q Q Q Q Q to Q ,671/403,398 17,706/97,272 17,524/95,402 17,563/96,293 18,058/99,567 70,851/388, % 18.2% 18.4% 18.2% 18.1% 18.2% Nation % Table 2: Number of Emergency Department (ED) Visits Q Q Q Q Q Q , , , ,703 Table 3: Number of Observation Stays Q Q Q Q Q Q ,273 26,208 24,928 24,069 1 National data are obtained from the Integrated Care for Populations and Communities (ICPC) Quarterly Scorecard and the most recent data available are through December 31, Page 1

3 Table 4: All-Cause Average Readmissions Rates by Region Region Average Rate Northeast 18.7% Central 18.5% Southeast 18.5% Southwest 18.1% Northwest 16.8% Page 2

4 Figure 1: and National Outpatient ED Visits, Observation Stays, and Inpatient Admissions 2,3 2 ED visits and observation stays resulting in an inpatient stay are not included in this calculation. 3 National data are obtained from the ICPC Quarterly Scorecard and the most recent data available are through December 31, Page 3

5 Table 5: Discharge Distribution after Inpatient Hospitalization for All Causes Q Q Readmits 30-Day Readmits to Same Hospital 30-Day Readmits to Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 16.2% 181,365 29,336 21, % 7, % 4, % 5, % 7, % 5, % 5, % SNF* 20.8% 94,498 19,686 14, % 5, % 2, % 3, % 5, % 3, % 4, % HHA** 21.3% 70,596 15,005 11, % 3, % 2, % 2, % 3, % 2, % 2, % Hospice 2.0% 12, % % % % % % % Other 21.9% 30,001 6,585 3, % 2, % 1, % % 1, % 1, % 1, % Total 18.2% 388,534 70,851 51, % 19, % 11, % 13, % 17, % 13, % 14, % *Skilled Nursing Facility (SNF) **Home Health Agency (HHA) Figure 2: 30-Day All-Cause Readmission Rates 5 4 An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 5 National data are obtained from the ICPC Quarterly Scorecard and the most recent data available are through December 31, Page 4

6 Table 6: Discharge Distribution after Inpatient Hospitalization for Acute Myocardial Infarction (AMI) Q Q Day Readmits to 30-Day Readmits to Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 13.7% 5, % % % % % % % SNF 24.9% 1, % % % % % % % HHA 23.9% 1, % % % % % % % Hospice 1.8% % % % % 0 0.0% 0 0.0% % Other 27.0% % % % % % % % Total 17.8% 9,631 1,718 1, % % % % % % % Figure 3: 30-Day AMI Readmission Rates 7 6 An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 7 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 through June 30, Page 5

7 Table 7: Discharge Distribution after Inpatient Hospitalization for Heart Failure (HF) Q Q Day Readmits to 30-Day Readmits to Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 22.5% 10,328 2,323 1, % % % % % % % SNF 26.9% 5,537 1,489 1, % % % % % % % HHA 28.8% 5,833 1,680 1, % % % % % % % Hospice 2.5% 1, % % % % % % % Other 30.2% 1, % % % % % % % Total 24.6% 24,020 5,900 4, % 1, % % 1, % 1, % 1, % 1, % Figure 4: 30-Day HF Readmission Rates 9 8 An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 9 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 through June 30, Page 6

8 Table 8: Discharge Distribution after Inpatient Hospitalization for Coronary Artery Bypass Graft (CABG) Q Q Day Readmits to 30-Day Readmits to Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 8.9% % % % % % % 3 7.9% SNF 19.7% % % % % % % % HHA 12.5% 1, % % % % % % % Hospice 0.0% ND 0 ND 0 ND 0 ND 0 ND 0 ND 0 ND Other 22.0% % % % % % % % Total 14.9% 2, % % % % % % % Figure 5: 30-Day CABG Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 11 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 through June 30, Page 7

9 Table 9: Discharge Distribution after Inpatient Hospitalization for Pneumonia (PNE) Q Q Day Readmits to 30-Day Readmits to Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 15.7% 9,260 1,456 1, % % % % % % % SNF 23.2% 7,017 1,631 1, % % % % % % % HHA 23.4% 3, % % % % % % % Hospice 1.9% 1, % % % % % % % Other 22.4% 1, % % % % % % % Total 18.9% 23,604 4,472 3, % 1, % % % 1, % % % Figure 6: 30-Day PNE Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 13 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 through June 30, Page 8

10 Table 10: Discharge Distribution after Inpatient Hospitalization for Chronic Obstructive Pulmonary Disease (COPD) Q Q Readmits 30-Day Readmits to Same Hospital 30-Day Readmits to Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 19.2% 11,805 2,271 1, % % % % % % % SNF 27.1% 3, % % % % % % % HHA 26.9% 4,653 1,252 1, % % % % % % % Hospice 2.7% % % % % % % % Other 27.3% 1, % % % % % % % Total 22.1% 21,750 4,811 3, % 1, % % % 1, % 1, % 1, % Figure 7: 30-Day COPD Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 15 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 through June 30, Page 9

11 Table 11: Discharge Distribution after Inpatient Hospitalization for Total Hip/Knee Replacement (THA/TKA) Q Q Day Readmits to 30-Day Readmits to Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 3.0% 5, % % % % % % % SNF 5.9% 4, % % % % % % % HHA 3.5% 7, % % % % % % % Hospice 20.0% % 0 0.0% 0 0.0% 0 0.0% % 0 0.0% 0 0.0% Other 6.3% 1, % % % % % % % Total 4.1% 19, % % % % % % % Figure 8: 30-Day THA/TKA Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 17 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 through June 30, Page 10

12 Methodology and Data Source Information The dashboard provides information regarding your state s all-cause, acute myocardial infarction (AMI), heart failure (HF), coronary artery bypass graft (CABG), 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. Planned readmissions are excluded from this analysis. Data in this report are limited to Medicare FFS Part-A data for discharges from April 1, 2016, to March 31, International Classification of Diseases (ICD)-10 codes are used to calculate rates starting from October 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. As more mature data become available, historic data may change slightly to reflect the updated data. The time periods illustrated in this document are examples only and may not reflect the most current data period. Pages 1 through 3 contain the following information. 1 Summary table 3 Regional map 2 Emergency department (ED) visits and observation stays tables 4 Outpatient ED visits, observation stays, and inpatient admissions graphs 1 Example Dashboard (Pages 1 through 3) 2 18 The Complete Standard Analytical Table (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 state s results. Page A

13 3 4 Example Outpatient ED Visits, Observation Stays, and Inpatient Admissions Dashboard Page B

14 1 Summary Table The summary table contains your state 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 the national rate. 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 observations stays tables provide the count of ED visits and observations stays, respectively, for each quarter in the current report period. ED visits and observation stays resulting in an inpatient stay are not included in the counts. 3 Regional Map The state of was divided into five regions: Northeast, Northwest, Central, Southeast, and Southwest. Aggregate readmission rates are calculated for each region using the hospitals located in the region. The table shows regional readmission rates for each region. 4 Outpatient ED Visits, Observation Stays, and Inpatient Admissions The two graphs depict the volume of outpatient ED visits, observation stays, and inpatient admissions for the state and the nation. The purpose of each is to monitor acute care utilization at the 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. Page C

15 Pages 4 through 10 provide the following data for all-cause and disease-specific 30-day readmissions: 5 Discharge distribution table 6 Line graph Example Dashboard (discharge distribution and line graph) 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. 6 Line graph The purpose of the readmission graph is to track readmission rates over time. The Line Graph shows your state s improvement in relation to nation. Rates are calculated quarterly. Page D

16 Measure Definitions All-Cause 30-Day Readmission Rates 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. Planned Readmissions A planned readmission is a readmission within 30 days of discharge from a short-term acute care hospital that is a scheduled part of the patient s plan of care. Planned readmissions are excluded from this report. Condition-Specific 30-Day Readmission Rates When calculating disease-specific readmission rates, an admission is included if the principal diagnosis/procedure code for the admission specifies that disease (i.e., AMI, HF, CABG, 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, CABG, PNE, COPD, and THA/TKA. ED Visits and Observation Stays The following table lists the codes used to identify ED visits and observations stays. Revenue Codes ED Visits 0450, 0451, 0452, 0456, 0459, 0981 HCPCS Observation Stays 0762, 0760 AND G0378 Page E

17 Hospitals by Region Central BERGER HOSPITAL BUCYRUS COMMUNITY HOSPITAL DILEY RIDGE MEDICAL CENTER DOCTORS HOSPITAL DUBLIN METHODIST HOSPITAL DUBLIN SPRINGS FAIRFIELD MEDICAL CENTER FAYETTE COUNTY MEMORIAL HOSPITAL GALION COMMUNITY HOSPITAL GRADY MEMORIAL HOSPITAL GRANT MEDICAL CENTER HARDIN MEMORIAL HOSPITAL JAMES CANCER HOSPITAL & SOLOVE RESEARCH INSTITUTE KNOX COMMUNITY HOSPITAL LICKING MEMORIAL HOSPITAL MADISON COUNTY HOSPITAL INC MARION GENERAL HOSPITAL MEMORIAL HOSPITAL MORROW COUNTY HOSPITAL MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL MOUNT CARMEL ST. ANN'S MOUNT CARMEL WEST OHIO HOSPITAL FOR PSYCHIATRY OHIO STATE UNIVERSITY HOSPITALS OHIOHEALTH MANSFIELD HOSPITAL OHIOHEALTH SHELBY HOSPITAL RIVERSIDE METHODIST HOSPITAL TWIN VALLEY BEHAVIORAL HEALTHCARE UNIVERSITY HOSPITALS SAMARITAN MEDICAL CENTER WOODS AT PARKSIDE,THE WYANDOT MEMORIAL HOSPITAL Northeast AFFINITY MEDICAL CENTER AKRON GENERAL MEDICAL CENTER ALLIANCE COMMUNITY HOSPITAL ASHTABULA COUNTY MEDICAL CENTER AULTMAN HOSPITAL AULTMAN ORRVILLE HOSPITAL CLEAR VISTA HEALTH & WELLNESS CLEVELAND CLINIC CLEVELAND CLINIC AVON HOSPITAL CRYSTAL CLINIC ORTHOPAEDIC CENTER EAST LIVERPOOL CITY HOSPITAL EUCLID HOSPITAL FAIRVIEW HOSPITAL GENERATIONS BEHAVIORAL HEALTH - GENEVA GLENBEIGH HEALTH SOURCES HEARTLAND BEHAVIORAL HEALTHCARE HIGHLAND SPRINGS HILLCREST HOSPITAL LAKE HEALTH LAKEWOOD HOSPITAL LODI COMMUNITY HOSPITAL LUTHERAN HOSPITAL MARYMOUNT HOSPITAL MEDINA HOSPITAL MERCY ALLEN HOSPITAL MERCY MEDICAL CENTER MERCY REGIONAL MEDICAL CENTER METROHEALTH SYSTEM NORTHCOAST BEHAVIORAL HEALTHCARE NORTHFIELD CAMPUS NORTHSIDE MEDICAL CENTER PARMA COMMUNITY GENERAL HOSPITAL SALEM REGIONAL MEDICAL CENTER SOUTH POINTE HOSPITAL SOUTHWEST GENERAL HEALTH CENTER ST. ELIZABETH BOARDMAN HEALTH CENTER ST. ELIZABETH YOUNGSTOWN HOSPITAL ST. JOHN MEDICAL CENTER ST. JOSEPH WARREN HOSPITAL ST. VINCENT CHARITY MEDICAL CENTER SUMMA HEALTH SYSTEM SUMMA WESTERN RESERVE HOSPITAL SURGICAL HOSPITAL AT SOUTHWOODS TRUMBULL MEMORIAL HOSPITAL UH CLEVELAND MEDICAL CENTER UH GEAUGA MEDICAL CENTER UHHS MEMORIAL HOSPITAL OF GENEVA UHHS RICHMOND HEIGHTS HOSPITAL UNIVERSITY HOSPITALS - ELYRIA MEDICAL CENTER UNIVERSITY HOSPITALS AHUJA MEDICAL CENTER UNIVERSITY HOSPITALS CONNEAUT MEDICAL CENTER UNIVERSITY HOSPITALS PORTAGE MEDICAL CENTER WINDSOR LAURELWOOD CENTER FOR BEHAVIORAL MEDICINE WOOSTER COMMUNITY HOSPITAL Northwest ARROWHEAD BEHAVIORAL HEALTH BAY PARK COMMUNITY HOSPITAL BELLEVUE HOSPITAL BLANCHARD VALLEY HOSPITAL BLUFFTON HOSPITAL COMMUNITY HOSPITALS AND WELLNESS CENTERS COMMUNITY HOSPITALS AND WELLNESS CENTERS COMMUNITY MEMORIAL HOSPITAL DEFIANCE REGIONAL MEDICAL CENTER FIRELANDS REGIONAL MEDICAL CENTER FISHER-TITUS HOSPITAL FLOWER HOSPITAL FOSTORIA COMMUNITY HOSPITAL FULTON COUNTY HEALTH CENTER GRAND LAKE HEALTH SYSTEM H B MAGRUDER MEMORIAL HOSPITAL HENRY COUNTY HOSPITAL, INC INSTITUTE FOR ORTHOPAEDIC SURGERY LIMA MEMORIAL HEALTH SYSTEM MEMORIAL HOSPITAL MERCER COUNTY JOINT TOWNSHIP COMMUNITY HOSPITAL MERCY HOSPITAL OF DEFIANCE MERCY ST. ANNE HOSPITAL MERCY ST. CHARLES HOSPITAL MERCY ST. VINCENT MEDICAL CENTER MERCY TIFFIN HOSPITAL MERCY WILLARD HOSPITAL NORTHWEST OHIO PSYCHIATRIC HOSPITAL PAULDING COUNTY HOSPITAL RIDGEVIEW BEHAVIORAL HOSPITAL SOJOURN AT SENECA ST. LUKE'S HOSPITAL ST. RITA'S MEDICAL CENTER TOLEDO HOSPITAL THE UNIVERSITY OF TOLEDO MEDICAL CENTER VAN WERT COUNTY HOSPITAL Page F

18 WOOD COUNTY HOSPITAL Southeast ADAMS COUNTY REGIONAL MEDICAL CENTER ADENA PIKE MEDICAL CENTER ADENA REGIONAL MEDICAL CENTER APPALACHIAN BEHAVIORAL HEALTH CARE BARNESVILLE HOSPITAL ASSOCIATION, INC BELMONT COMMUNITY HOSPITAL CAMBRIDGE BEHAVIORAL HOSPITAL COSHOCTON REGIONAL MEDICAL CENTER EAST OHIO REGIONAL HOSPITAL GENESIS HOSPITAL GREENFIELD AREA MEDICAL CENTER HARRISON COMMUNITY HOSPITAL HIGHLAND DISTRICT HOSPITAL HOCKING VALLEY COMMUNITY HOSPITAL HOLZER MEDICAL CENTER HOLZER MEDICAL CENTER JACKSON KINGS DAUGHTERS MEDICAL CENTER OHIO MARIETTA MEMORIAL HOSPITAL OHIOHEALTH O'BLENESS HOSPITAL POMERENE HOSPITAL SELBY GENERAL HOSPITAL SOUTHEASTERN OHIO REGIONAL MEDICAL CENTER SOUTHERN OHIO MEDICAL CENTER TEN LAKES CENTER, LLC THREE GABLES SURGERY CENTER UNION HOSPITAL TRINITY HOSPITAL TWIN CITY Southwest TRINITY MEDICAL CTR EAST &TRINITY MEDICAL CTR WEST ACCESS HOSPITAL DAYTON, LLC ASSURANCE HEALTH CINCINNATI LLC ATRIUM MEDICAL CENTER BECKETT SPRINGS BETHESDA NORTH CHRIST HOSPITAL CLINTON MEMORIAL HOSPITAL FORT HAMILTON HUGHES MEMORIAL HOSPITAL GOOD SAMARITAN HOSPITAL GOOD SAMARITAN HOSPITAL GRANDVIEW HOSPITAL & MEDICAL CENTER GREENE MEMORIAL HOSPITAL HAVEN BEHAVIORAL HOSPITAL OF DAYTON JEWISH HOSPITAL, LLC KETTERING MEDICAL CENTER LINDNER CENTER OF HOPE MARY RUTAN HOSPITAL MCCULLOUGH-HYDE MEMORIAL HOSPITAL MEDICAL CENTER AT ELIZABETH PLACE MENTAL HEALTH SERVICES FOR CLARK AND MADISON COS MERCY HEALTH - WEST HOSPITAL MERCY HOSPITAL ANDERSON MERCY HOSPITAL CLERMONT MERCY HOSPITAL FAIRFIELD MERCY MEMORIAL HOSPITAL MIAMI VALLEY HOSPITAL OHIO VALLEY MEDICAL CENTER, LLC SOIN MEDICAL CENTER SPRINGFIELD REGIONAL MEDICAL CENTER SUMMIT BEHAVIORAL HEALTHCARE SYCAMORE MEDICAL CENTER TRIHEALTH EVENDALE HOSPITAL UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC UPPER VALLEY MEDICAL CENTER WAYNE HOSPITAL WEST CHESTER HOSPITAL, LLC WILSON MEMORIAL HOSPITAL Page G