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 813.865.3438 for additional information
Overview Table 1: 30-Day All-Cause Readmission Rates Q3 2013 Q2 2014 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 4,369/23,342 19.1% 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 1 18.0% RIR to Date Table 5: All-Cause Average Readmissions Rates by Region Region Average Rate Region 1 17.3% 18.5% Region 3 19.4% Region 4 20.7% Region 5 18.4% Region 6 22.7% Region 7 16.6% Region 8 19.3% Table 2: Number of Emergency Department (ED) Visits Q3 2013 Q2 2014 1 Q3 2013 Q4 2013 Q1 2014 Q2 2014 21,578 23,436 23,445 22,852 Florida 180,722 195,679 210,015 195,953 Table 3: Number of Observation Stays Q3 2013 Q2 2014 2 Q3 2013 Q4 2013 Q1 2014 Q2 2014 4,640 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 Q3 2013 Q2 2014 2 Discharges to Home Total Follow-up in 30 Days % Follow-up Readmitted Count Follow-up Count % with Follow-up Days Count % No 28,529 21,542 75.5% 01 to 14 16,797 78.0% 34,271 24,468 71.4% 15 to 30 4,745 22.0% Yes 5,742 2,926 51.0% 01 to 14 2,671 91.3% 15 to 30 255 8.7% 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
Encounters by Millions Encounters by Thousands Figure 1: Florida and National Outpatient ED Visits, Observation Stays, and Inpatient Admissions 3,4 250 200 150 100 50 0 Florida ED Visits Florida Observation Stays Florida Admissions Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 4 National ED Visits National Observation Stays National Admissions 2 0 Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 3 ED visits and observations stays resulting in an inpatient stay are not included in this calculation. 4 National data are unavailable for Q1 2014. March 2015 Page 2
All-Cause Readmission Rate Table 6: Discharge Distribution after Inpatient Hospitalization for All Causes Q3 2013 Q2 2014 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 15 21 Days 22 30 Days N % N % N % N % N % Home 17.0% 44,453 7,553 5,703 75.5% 1,850 24.5% 1,268 16.8% 1,392 18.4% 1,894 25.1% 1,436 19.0% 1,563 20.7% SNF 21.6% 18,193 3,921 3,112 79.4% 809 20.6% 600 15.3% 723 18.4% 1,029 26.2% 792 20.2% 777 19.8% HHA 20.8% 17,970 3,731 3,011 80.7% 720 19.3% 677 18.1% 727 19.5% 910 24.4% 722 19.4% 695 18.6% Hospice 1.8% 3,763 67 51 76.1% 16 23.9% 16 23.9% 8 11.9% 22 32.8% 8 11.9% 13 19.4% Other 23.6% 7,093 1,673 1,029 61.5% 644 38.5% 467 27.9% 262 15.7% 348 20.8% 283 16.9% 313 18.7% Total 18.5% 91,472 16,945 12,906 76.2% 4,039 23.8% 3,028 17.9% 3,112 18.4% 4,203 24.8% 3,241 19.1% 3,361 19.8% Home 17.8% 345,669 61,699 45,067 73.0% 16,632 27.0% 10,668 17.3% 11,596 18.8% 15,338 24.9% 11,891 19.3% 12,206 19.8% SNF 22.4% 160,040 35,811 27,310 76.3% 8,501 23.7% 5,469 15.3% 6,520 18.2% 9,237 25.8% 7,241 20.2% 7,344 20.5% HHA 21.2% 150,438 31,861 25,452 79.9% 6,409 20.1% 5,414 17.0% 6,307 19.8% 8,141 25.6% 5,922 18.6% 6,077 19.1% Hospice 2.6% 28,791 761 539 70.8% 222 29.2% 179 23.5% 146 19.2% 199 26.1% 113 14.8% 124 16.3% Other 22.9% 64,822 14,842 9,136 61.6% 5,706 38.4% 3,471 23.4% 2,494 16.8% 3,287 22.1% 2,687 18.1% 2,903 19.6% Total 19.3% 749,760 144,974 107,504 74.2% 37,470 25.8% 25,201 17.4% 27,063 18.7% 36,202 25.0% 27,854 19.2% 28,654 19.8% Figure 2: 30-Day All-Cause Readmission Rates 5 25% 20% 15% 10% 5% 0% Region State Nation Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 5 National data are obtained from the ICPC Quarterly Scorecard (January 1, 2013 through December 31, 2013). March 2015 Page 3
AMI Readmission Rate Table 7: Discharge Distribution after Inpatient Hospitalization for Acute Myocardial Infarction (AMI) Q3 2013 Q2 2014 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 15 21 Days 22 30 Days N % N % N % N % N % Home 16.6% 1,305 217 181 83.4% 36 16.6% 50 23.0% 41 18.9% 55 25.3% 35 16.1% 36 16.6% SNF 29.6% 378 112 89 79.5% 23 20.5% 23 20.5% 15 13.4% 32 28.6% 22 19.6% 20 17.9% HHA 29.5% 339 100 83 83.0% 17 17.0% 24 24.0% 27 27.0% 19 19.0% 15 15.0% 15 15.0% Hospice 0.9% 111 1 0 0.0% 1 100.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 100.0% Other 36.7% 147 54 31 57.4% 23 42.6% 29 53.7% 2 3.7% 8 14.8% 4 7.4% 11 20.4% Total 21.2% 2,280 484 384 79.3% 100 20.7% 126 26.0% 85 17.6% 114 23.6% 76 15.7% 83 17.1% Home 15.2% 8,357 1,267 1002 79.1% 265 20.9% 293 23.1% 243 19.2% 308 24.3% 208 16.4% 215 17.0% SNF 29.0% 2,577 748 569 76.1% 179 23.9% 139 18.6% 130 17.4% 171 22.9% 150 20.1% 158 21.1% HHA 25.7% 2,884 741 581 78.4% 160 21.6% 143 19.3% 172 23.2% 191 25.8% 117 15.8% 118 15.9% Hospice 1.8% 760 14 9 64.3% 5 35.7% 2 14.3% 1 7.1% 7 50.0% 1 7.1% 3 21.4% Other 30.8% 1,330 409 234 57.2% 175 42.8% 152 37.2% 68 16.6% 72 17.6% 58 14.2% 59 14.4% Total 20.0% 15,908 3,179 2395 75.3% 784 24.7% 729 22.9% 614 19.3% 749 23.6% 534 16.8% 553 17.4% Figure 3: 30-Day AMI Readmission Rates 6 25% <<figure3>> Region State Nation 20% 15% 10% 5% 0% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 6 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, 2012. March 2015 Page 4
HF Readmission Rate Table 8: Discharge Distribution after Inpatient Hospitalization for Heart Failure (HF) Q3 2013 Q2 2014 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 15 21 Days 22 30 Days N % N % N % N % N % Home 25.0% 2,348 586 457 78.0% 129 22.0% 100 17.1% 102 17.4% 145 24.7% 121 20.6% 118 20.1% SNF 29.4% 948 279 226 81.0% 53 19.0% 34 12.2% 43 15.4% 84 30.1% 61 21.9% 57 20.4% HHA 31.5% 1,187 374 319 85.3% 55 14.7% 63 16.8% 70 18.7% 107 28.6% 74 19.8% 60 16.0% Hospice 0.3% 304 1 1 100.0% 0 0.0% 0 0.0% 0 0.0% 1 100.% 0 0.0% 0 0.0% Other 29.2% 308 90 57 63.3% 33 36.7% 31 34.4% 16 17.8% 14 15.6% 13 14.4% 16 17.8% Total 26.1% 5,095 1,330 1,060 79.7% 270 20.3% 228 17.1% 231 17.4% 351 26.4% 269 20.2% 251 18.9% Home 24.6% 15,734 3,873 3,045 78.6% 828 21.4% 563 14.5% 673 17.4% 995 25.7% 800 20.7% 842 21.7% SNF 31.5% 7,598 2,393 1,885 78.8% 508 21.2% 312 13.0% 433 18.1% 632 26.4% 508 21.2% 508 21.2% HHA 28.7% 10,111 2,903 2,370 81.6% 533 18.4% 439 15.1% 551 19.0% 810 27.9% 544 18.7% 559 19.3% Hospice 2.8% 2,082 59 47 79.7% 12 20.3% 16 27.1% 11 18.6% 12 20.3% 6 10.2% 14 23.7% Other 31.5% 2,562 808 526 65.1% 282 34.9% 193 23.9% 123 15.2% 174 21.5% 151 18.7% 167 20.7% Total 26.4% 38,087 10,036 7,873 78.4% 2,163 21.6% 1,523 15.2% 1,791 17.8% 2,623 26.1% 2,009 20.0% 2,090 20.8% Figure 4: 30-Day HF Readmission Rates 7 <<figure4>> 30% Region State Nation 20% 10% 0% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 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 from July 1, 2009 through June 30, 2012. March 2015 Page 5
PNE Readmission Rate Table 9: Discharge Distribution after Inpatient Hospitalization for Pneumonia (PNE) Q3 2013 Q2 2014 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 15 21 Days 22 30 Days N % N % N % N % N % Home 16.4% 1,709 280 220 78.6% 60 21.4% 55 19.6% 51 18.2% 60 21.4% 58 20.7% 56 20.0% SNF 25.1% 661 166 138 83.1% 28 16.9% 30 18.1% 28 16.9% 41 24.7% 32 19.3% 35 21.1% HHA 25.8% 581 150 125 83.3% 25 16.7% 25 16.7% 25 16.7% 33 22.0% 30 20.0% 37 24.7% Hospice 1.5% 205 3 2 66.7% 1 33.3% 0 0.0% 0 0.0% 1 33.3% 0 0.0% 2 66.7% Other 23.5% 264 62 40 64.5% 22 35.5% 13 21.0% 16 25.8% 11 17.7% 9 14.5% 13 21.0% Total 19.3% 3,420 661 525 79.4% 136 20.6% 123 18.6% 120 18.2% 146 22.1% 129 19.5% 143 21.6% Home 15.6% 12,020 1,874 1,463 78.1% 411 21.9% 374 20.0% 325 17.3% 436 23.3% 343 18.3% 396 21.1% SNF 24.7% 5,883 1,452 1,150 79.2% 302 20.8% 205 14.1% 265 18.3% 383 26.4% 300 20.7% 299 20.6% HHA 22.6% 5,415 1,225 1,011 82.5% 214 17.5% 220 18.0% 226 18.4% 303 24.7% 235 19.2% 241 19.7% Hospice 3.2% 1,377 44 29 65.9% 15 34.1% 11 25.0% 10 22.7% 9 20.5% 5 11.4% 9 20.5% Other 22.2% 1,962 436 281 64.4% 155 35.6% 104 23.9% 81 18.6% 101 23.2% 66 15.1% 84 19.3% Total 18.9% 26,657 5,031 3,934 78.2% 1,097 21.8% 914 18.2% 907 18.0% 1,232 24.5% 949 18.9% 1,029 20.5% Figure 5: 30-Day PNE Readmission Rates 8 25% Region State Nation 20% 15% 10% 5% 0% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 8 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, 2012. March 2015 Page 6
COPD Readmission Rate Table 10: Discharge Distribution after Inpatient Hospitalization for Chronic Obstructive Pulmonary Disease (COPD) Q3 2013 Q2 2014 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 15 21 Days 22 30 Days N % N % N % N % N % Home 19.9% 2,720 542 444 81.9% 98 18.1% 73 13.5% 70 12.9% 143 26.4% 123 22.7% 133 24.5% SNF 25.0% 560 140 116 82.9% 24 17.1% 18 12.9% 25 17.9% 39 27.9% 30 21.4% 28 20.0% HHA 28.9% 848 245 205 83.7% 40 16.3% 40 16.3% 37 15.1% 53 21.6% 64 26.1% 51 20.8% Hospice 2.3% 132 3 3 100.0% 0 0.0% 0 0.0% 0 0.0% 1 33.3% 1 33.3% 1 33.3% Other 24.7% 279 69 41 59.4% 28 40.6% 19 27.5% 7 10.1% 11 15.9% 12 17.4% 20 29.0% Total 22.0% 4,539 999 809 81.0% 190 19.0% 150 15.0% 139 13.9% 247 24.7% 230 23.0% 233 23.3% Home 20.6% 18,023 3,704 3,004 81.1% 700 18.9% 582 15.7% 589 15.9% 947 25.6% 773 20.9% 813 21.9% SNF 27.7% 4,663 1,292 1,002 77.6% 290 22.4% 184 14.2% 202 15.6% 329 25.5% 281 21.7% 296 22.9% HHA 26.7% 7,007 1,873 1,597 85.3% 276 14.7% 285 15.2% 294 15.7% 496 26.5% 400 21.4% 398 21.2% Hospice 3.6% 887 32 22 68.8% 10 31.3% 5 15.6% 6 18.8% 8 25.0% 8 25.0% 5 15.6% Other 27.7% 2,180 603 380 63.0% 223 37.0% 134 22.2% 92 15.3% 126 20.9% 124 20.6% 127 21.1% Total 22.9% 32,760 7,504 6,005 80.0% 1,499 20.0% 1,190 15.9% 1,183 15.8% 1,906 25.4% 1,586 21.1% 1,639 21.8% Figure 6: 30-Day COPD Readmission Rates 9 <<figure6>> 30% Region State 20% 10% 0% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 9 National COPD data are unavailable on the Hospital Compare website. March 2015 Page 7
TKA/THA Readmission Rate Table 11: Discharge Distribution after Inpatient Hospitalization for Total Hip/Knee Replacement (THA/TKA) Q3 2013 Q2 2014 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 15 21 Days 22 30 Days N % N % N % N % N % Home 3.9% 76 3 2 66.7% 1 33.3% 1 33.3% 1 33.3% 1 33.3% 0 0.0% 0 0.0% SNF 6.7% 1,289 87 64 73.6% 23 26.4% 16 18.4% 13 14.9% 25 28.7% 12 13.8% 21 24.1% HHA 3.9% 1,850 73 65 89.0% 8 11.0% 13 17.8% 22 30.1% 12 16.4% 10 13.7% 16 21.9% Hospice 0.0% 3 0 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other 10.1% 158 16 15 93.8% 1 6.3% 3 18.8% 1 6.3% 4 25.0% 5 31.3% 3 18.8% Total 5.3% 3,376 179 146 81.6% 33 18.4% 33 18.4% 37 20.7% 42 23.5% 27 15.1% 40 22.3% Home 4.0% 1,494 60 50 83.3% 10 16.7% 13 21.7% 20 33.3% 9 15.0% 10 16.7% 8 13.3% SNF 6.7% 10,574 704 518 73.6% 186 26.4% 121 17.2% 130 18.5% 181 25.7% 126 17.9% 146 20.7% HHA 4.1% 13,557 556 422 75.9% 134 24.1% 95 17.1% 140 25.2% 137 24.6% 79 14.2% 105 18.9% Hospice 0.0% 8 0 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% Other 8.7% 1,917 166 124 74.7% 42 25.3% 27 16.3% 29 17.5% 44 26.5% 31 18.7% 35 21.1% Total 5.4% 27,550 1,486 1,114 75.0% 372 25.0% 256 17.2% 319 21.5% 371 25.0% 246 16.6% 294 19.8% Figure 7: 30-Day THA/TKA Readmission Rates 10 8% 6% 4% 2% Region State Nation 0% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 10 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, 2012. March 2015 Page 8
Table 12: Top 10 Index Admission Diagnosis Related Groups (DRGs) for Q3 2013 Q2 2014 11 DRG 12 Code Description N % 470 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC 3,743 4.1% 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC 2,710 3.0% 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 2,648 2.9% 885 PSYCHOSES 1,934 2.1% 292 HEART FAILURE & SHOCK W CC 1,884 2.1% 291 HEART FAILURE & SHOCK W MCC 1,834 2.0% 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC 1,708 1.9% 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 1,635 1.8% 191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC 1,381 1.5% 683 RENAL FAILURE W CC 1,373 1.5% Table 13: Top 10 Readmission DRGs for Q3 2013 Q2 2014 13 DRG Code Description N % 871 SEPTICEMIA OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC 868 5.2% 291 HEART FAILURE & SHOCK W MCC 641 3.8% 292 HEART FAILURE & SHOCK W CC 484 2.9% 392 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC 404 2.4% 885 PSYCHOSES 369 2.2% 683 RENAL FAILURE W CC 338 2.0% 682 RENAL FAILURE W MCC 313 1.9% 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC 311 1.9% 690 KIDNEY & URINARY TRACT INFECTIONS W/O MCC 264 1.6% 378 G.I. HEMORRHAGE W CC 262 1.6% 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
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, 2014. 14 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) 4 1 2 3 14 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
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
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
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
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
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 15 410.00, 410.01, 410.10, 410.11, 410.20, 410.21, 410.30, 410.31, 410.40, 410.41, 410.50, 410.51, 410.60, 410.61, 410.70, 410.71, 410.80, 410.81, 410.90, 410.91 HF 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428 PNE 480.0, 480.1, 480.2, 480.3, 480.8, 480.9, 481.0, 482.0, 482.1, 482.2, 482.3, 482.31, 482.32, 482.39, 482.4, 482.41, 482.42, 482.49, 482.81, 482.82, 482.83, 482.84, 482.89, 482.9, 483.0, 483.1, 483.8, 485.0, 486.0, 487.0, 488.11 COPD 491.21, 491.22, 491.8, 491.9, 492.8, 493.20, 493.21, 493.22, 496, 518.81*, 518.82*, 518.84*, 799.1* Procedure Procedural Codes THA/TKA 16 81.51, 81.54 * Principal diagnosis when combined with a secondary diagnosis of COPD (491.21, 491.22, 493.21, or 493.22) 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 G0378 15 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
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.3-04092015-03 March 2015 Page G