Medicare Fee-For-Service (FFS) Hospital Readmissions: Q2 2016 Q1 2017 State of Please contact Barb Averyt via email at BAveryt@hsag.com or by phone at 602.801.6902 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. AZ-11SOW-C.3-08222017-01
Overview Table 1: 30-Day All-Cause Readmission Rates Q2 2016 Q1 2017 1 Baseline Current (CY 2013) Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2016 to Q1 2017 25,963/160,061 6,124/38,545 5,671/35,226 5,962/38,033 6,737/44,003 24,494/155,807 16.2% 15.9% 16.1% 15.7% 15.3% 15.7% Nation 1 18.4% Table 2: Number of Emergency Department (ED) Visits Q2 2016 Q1 2017 Q2 2016 Q3 2016 Q4 2016 Q1 2017 61,765 57,070 63,409 70,784 Table 3: Number of Observation Stays Q2 2016 Q1 2017 Q2 2016 Q3 2016 Q4 2016 Q1 2017 13,977 13,494 14,772 15,655 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, 2016. Page 1
Table 4: All-Cause Average Readmissions Rates by Region Region Average Rate East Valley 16.7% Southern 16.0% West Valley 16.0% Central Valley 15.7% Western 15.3% Northern 13.2% Page 2
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, 2016. Page 3
Table 5: Discharge Distribution after Inpatient Hospitalization for All Causes Q2 2016 Q1 2017 4 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 15 21 Days 22 30 Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 14.1% 91,515 12,906 8,942 69.3% 3,964 30.7% 2,240 17.4% 2,452 19.0% 3,162 24.5% 2,507 19.4% 2,545 19.7% SNF* 19.9% 25,045 4,995 3,332 66.7% 1,663 33.3% 703 14.1% 907 18.2% 1,269 25.4% 1,088 21.8% 1,028 20.6% HHA** 19.0% 21,385 4,067 3,074 75.6% 993 24.4% 697 17.1% 821 20.2% 1,031 25.4% 748 18.4% 770 18.9% Hospice 1.9% 6,022 113 77 68.1% 36 31.9% 18 15.9% 27 23.9% 23 20.4% 16 14.2% 29 25.7% Other 20.4% 11,840 2,413 1,422 58.9% 991 41.1% 556 23.0% 412 17.1% 523 21.7% 498 20.6% 424 17.6% Total 15.7% 155,807 24,494 16,847 68.8% 7,647 31.2% 4,214 17.2% 4,619 18.9% 6,008 24.5% 4,857 19.8% 4,796 19.6% *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, 2016. Page 4
Table 6: Discharge Distribution after Inpatient Hospitalization for Acute Myocardial Infarction (AMI) Q2 2016 Q1 2017 6 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 15 21 Days 22 30 Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 11.0% 2,873 315 220 69.8% 95 30.2% 72 22.9% 62 19.7% 71 22.5% 54 17.1% 56 17.8% SNF 23.9% 423 101 68 67.3% 33 32.7% 19 18.8% 18 17.8% 32 31.7% 19 18.8% 13 12.9% HHA 20.9% 406 85 62 72.9% 23 27.1% 23 27.1% 19 22.4% 13 15.3% 15 17.6% 15 17.6% Hospice 3.3% 152 5 4 80.0% 1 20.0% 0 0.0% 1 20.0% 0 0.0% 2 40.0% 2 40.0% Other 25.7% 226 58 23 39.7% 35 60.3% 26 44.8% 11 19.0% 7 12.1% 11 19.0% 3 5.2% Total 13.8% 4,080 564 377 66.8% 187 33.2% 140 24.8% 111 19.7% 123 21.8% 101 17.9% 89 15.8% 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, 2016. Page 5
Table 7: Discharge Distribution after Inpatient Hospitalization for Heart Failure (HF) Q2 2016 Q1 2017 8 30-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 15 21 Days 22 30 Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 20.9% 3,795 794 560 70.5% 234 29.5% 124 15.6% 162 20.4% 205 25.8% 153 19.3% 150 18.9% SNF 24.7% 957 236 151 64.0% 85 36.0% 34 14.4% 44 18.6% 63 26.7% 53 22.5% 42 17.8% HHA 23.9% 1,253 299 228 76.3% 71 23.7% 40 13.4% 49 16.4% 76 25.4% 65 21.7% 69 23.1% Hospice 2.9% 383 11 3 27.3% 8 72.7% 1 9.1% 0 0.0% 4 36.4% 4 36.4% 2 18.2% Other 29.0% 286 83 51 61.4% 32 38.6% 12 14.5% 15 18.1% 25 30.1% 20 24.1% 11 13.3% Total 21.3% 6,674 1,423 993 69.8% 430 30.2% 211 14.8% 270 19.0% 373 26.2% 295 20.7% 274 19.3% 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, 2016. Page 6
Table 8: Discharge Distribution after Inpatient Hospitalization for Coronary Artery Bypass Graft (CABG) Q2 2016 Q1 2017 10 30-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 15 21 Days 22 30 Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 8.4% 454 38 21 55.3% 17 44.7% 10 26.3% 11 28.9% 10 26.3% 3 7.9% 4 10.5% SNF 13.3% 196 26 16 61.5% 10 38.5% 5 19.2% 6 23.1% 11 42.3% 1 3.8% 3 11.5% HHA 12.7% 267 34 22 64.7% 12 35.3% 4 11.8% 8 23.5% 9 26.5% 9 26.5% 4 11.8% Hospice 0.0% 5 0 0 ND 0 ND 0 ND 0 ND 0 ND 0 ND 0 ND Other 18.2% 143 26 23 88.5% 3 11.5% 5 19.2% 7 26.9% 5 19.2% 6 23.1% 3 11.5% Total 11.6% 1,065 124 82 66.1% 42 33.9% 24 19.4% 32 25.8% 35 28.2% 19 15.3% 14 11.3% Figure 5: 30-Day CABG Readmission Rates 11 10 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, 2016. Page 7
Table 9: Discharge Distribution after Inpatient Hospitalization for Pneumonia (PNE) Q2 2016 Q1 2017 12 30-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 15 21 Days 22 30 Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 15.4% 5,340 820 597 72.8% 223 27.2% 136 16.6% 118 14.4% 237 28.9% 166 20.2% 163 19.9% SNF 22.2% 1,738 386 271 70.2% 115 29.8% 55 14.2% 70 18.1% 91 23.6% 96 24.9% 74 19.2% HHA 22.9% 1,442 330 257 77.9% 73 22.1% 60 18.2% 72 21.8% 81 24.5% 55 16.7% 62 18.8% Hospice 1.2% 801 10 7 70.0% 3 30.0% 3 30.0% 3 30.0% 2 20.0% 0 0.0% 2 20.0% Other 23.5% 562 132 78 59.1% 54 40.9% 28 21.2% 28 21.2% 19 14.4% 27 20.5% 30 22.7% Total 17.0% 9,883 1,678 1,210 72.1% 468 27.9% 282 16.8% 291 17.3% 430 25.6% 344 20.5% 331 19.7% Figure 6: 30-Day PNE Readmission Rates 13 12 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, 2016. Page 8
Table 10: Discharge Distribution after Inpatient Hospitalization for Chronic Obstructive Pulmonary Disease (COPD) Q2 2016 Q1 2017 14 30-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 15 21 Days 22 30 Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 16.4% 3,593 588 455 77.4% 133 22.6% 84 14.3% 101 17.2% 135 23.0% 138 23.5% 130 22.1% SNF 29.2% 623 182 125 68.7% 57 31.3% 19 10.4% 33 18.1% 53 29.1% 42 23.1% 35 19.2% HHA 26.3% 837 220 185 84.1% 35 15.9% 38 17.3% 30 13.6% 55 25.0% 50 22.7% 47 21.4% Hospice 2.9% 240 7 6 85.7% 1 14.3% 1 14.3% 0 0.0% 2 28.6% 0 0.0% 4 57.1% Other 28.2% 287 81 54 66.7% 27 33.3% 16 19.8% 13 16.0% 23 28.4% 17 21.0% 12 14.8% Total 19.3% 5,580 1,078 825 76.5% 253 23.5% 158 14.7% 177 16.4% 268 24.9% 247 22.9% 228 21.2% Figure 7: 30-Day COPD Readmission Rates 15 14 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, 2016. Page 9
Table 11: Discharge Distribution after Inpatient Hospitalization for Total Hip/Knee Replacement (THA/TKA) Q2 2016 Q1 2017 16 30-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 15 21 Days 22 30 Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 2.8% 5,660 157 101 64.3% 56 35.7% 40 25.5% 33 21.0% 31 19.7% 25 15.9% 28 17.8% SNF 6.5% 1,440 94 55 58.5% 39 41.5% 12 12.8% 21 22.3% 22 23.4% 16 17.0% 23 24.5% HHA 3.3% 2,707 90 58 64.4% 32 35.6% 29 32.2% 21 23.3% 15 16.7% 9 10.0% 16 17.8% Hospice 0.0% 5 0 0 ND 0 ND 0 ND 0 ND 0 ND 0 ND 0 ND Other 7.0% 359 25 18 72.0% 7 28.0% 9 36.0% 1 4.0% 5 20.0% 7 28.0% 3 12.0% Total 3.6% 10,171 366 232 63.4% 134 36.6% 90 24.6% 76 20.8% 73 19.9% 57 15.6% 70 19.1% Figure 8: 30-Day THA/TKA Readmission Rates 17 16 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, 2016. Page 10
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, 2017. 18 International Classification of Diseases (ICD)-10 codes are used to calculate rates starting from October 2015. 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
3 4 Example Outpatient ED Visits, Observation Stays, and Inpatient Admissions Dashboard Page B
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 six regions: Western (WAZ), Northern (NAZ), Southern (SAZ), West Valley Phoenix (WV Phoenix), Central Valley Phoenix (CV Phoenix), and East Valley Phoenix (EV Phoenix). 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
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) 5 6 5 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
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
Hospitals by Region Central Valley ABRAZO CENTRAL CAMPUS ABRAZO SCOTTSDALE CAMPUS ARIZONA STATE HOSPITAL BANNER - UNIVERSITY MEDICAL CENTER PHOENIX BANNER BEHAVIORAL HEALTH HOSPITAL COPPER SPRINGS HOSPITAL, LLC CORE INSTITUTE SPECIALTY HOSPITAL, THE HAVEN SENIOR HORIZONS HONORHEALTH DEER VALLEY MEDICAL CENTER HONORHEALTH JOHN C. LINCOLN MEDICAL CENTER HONORHEALTH SCOTTSDALE OSBORN MEDICAL CENTER HONORHEALTH SCOTTSDALE SHEA MEDICAL CENTER HONORHEALTH SCOTTSDALE THOMPSON PEAK MEDICAL CENTER MARICOPA MEDICAL CENTER MAYO CLINIC HOSPITAL O.A.S.I.S. HOSPITAL PHOENIX INDIAN MEDICAL CENTER QUAIL RUN BEHAVIORAL HEALTH ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER ST. LUKE'S BEHAVIORAL HOSPITAL, LP ST. LUKE'S MEDICAL CENTER VALLEY HOSPITAL East Valley ARIZONA SPECIALITY HOSPITAL ARIZONA SPINE AND JOINT HOSPITAL AURORA BEHAVIORAL HEALTHCARE-TEMPE BANNER BAYWOOD MEDICAL CENTER BANNER CASA GRANDE MEDICAL CENTER BANNER DESERT MEDICAL CENTER BANNER GATEWAY MEDICAL CENTER BANNER GOLDFIELD MEDICAL CENTER BANNER HEART HOSPITAL BANNER IRONWOOD MEDICAL CENTER CHANDLER REGIONAL MEDICAL CENTER FLORENCE HOSPITAL AT ANTHEM, LLC GILBERT HOSPITAL HUHU KAM MEMORIAL HOSPITAL MERCY GILBERT MEDICAL CENTER MOUNTAIN VISTA MEDICAL CENTER, LP OASIS BEHAVIORAL HEALTH HOSPITAL Northern BANNER PAYSON MEDICAL CENTER CHANGEPOINT PSYCHIATRIC HOSPITAL CHINLE COMPREHENSIVE HEALTH CARE FACILITY COBRE VALLEY REGIONAL MEDICAL CENTER FLAGSTAFF MEDICAL CENTER FORT DEFIANCE INDIAN HOSPITAL GUIDANCE CENTER, THE HOPI HEALTH CARE CENTER LITTLE COLORADO MEDICAL CENTER PAGE HOSPITAL SAGE MEMORIAL HOSPITAL SAN CARLOS APACHE HEALTHCARE SUMMIT HEALTHCARE REGIONAL MEDICAL CENTER TUBA CITY REGIONAL HEALTH CARE CORPORATION VERDE VALLEY MEDICAL CENTER WHITE MOUNTAIN REGIONAL MEDICAL CENTER WHITERIVER PHS INDIAN HOSPITAL WINDHAVEN PSYCHIATRIC HOSPITAL YAVAPAI REGIONAL MEDICAL CENTER BANNER-UNIVERSITY MEDICAL CENTER SOUTH CAMPUS YAVAPAI REGIONAL MEDICAL CENTER-EAST CAMPUS Southern BANNER-UNIVERSITY MEDICAL CENTER TUCSON CAMPUS BENSON HOSPITAL CANYON VISTA MEDICAL CENTER COPPER QUEEN COMMUNITY HOSPITAL GREEN VALLEY HOSPITAL HOLY CROSS HOSPITAL MT. GRAHAM REGIONAL MEDICAL CENTER NORTHERN COCHISE COMMUNITY HOSPITAL, INC. NORTHWEST MEDICAL CENTER ORO VALLEY HOSPITAL PALO VERDE BEHAVIORAL HEALTH SELLS HOSPITAL SONORA BEHAVIORAL HEALTH HOSPITAL ST. JOSEPH'S HOSPITAL ST. MARY'S HOSPITAL TUCSON MEDICAL CENTER West Valley ABRAZO ARROWHEAD CAMPUS ABRAZO MARYVALE CAMPUS ABRAZO WEST CAMPUS AURORA BEHAVIORAL HEALTH SYSTEM BANNER BOSWELL MEDICAL CENTER BANNER DEL E. WEBB MEDICAL CENTER BANNER ESTRELLA MEDICAL CENTER BANNER THUNDERBIRD MEDICAL CENTER DIGNITY HEALTH - ARIZONA GENERAL HOSPITAL WICKENBURG COMMUNITY HOSPITAL Western HAVASU REGIONAL MEDICAL CENTER KINGMAN REGIONAL MEDICAL CENTER LA PAZ REGIONAL HOSPITAL PARKER INDIAN HEALTH CENTER VALLEY VIEW MEDICAL CENTER WESTERN ARIZONA REGIONAL MEDICAL CENTER YUMA REGIONAL MEDICAL CENTER Page F