Transcript Slide 1

Steven J. Korzeniewski, PhD-Candidate, MSc, MA,
Director, Statistical Analysis Resource Group (SARG) & Chief Scientific Officer,
22670 Haggerty Rd Ste. 100, Farmington Hills, MI 48335
Telephone: (248) 465-7365, Email: [email protected]
•Most US hospitals are unable to identify their patients that readmit to other
hospitals. [Jencks SF, Williams MV, Coleman EA. Rehospitalizations Among Patients in the Medicare Fee-for-service Program. N
Engl J Med. 2009;360:1418-1428.]
•Hospitals lacking access to data on their patients that readmit elsewhere are
unable to:
Calculate their total readmission rates
Investigate trends
Evaluate performance
•National interest in reporting is mounting, particularly following the recent and
historic passage of healthcare reform legislation.
CMS now reports risk standardized rates for selected conditions, but these
represent a minority of overall readmissions
An infrastructure capable of such reporting did not exist in Michigan,
Until NOW….
Coordinate multi-payer data sharing to construct
readmission profiles for Michigan hospitals and
assist them in evaluating intervention effectiveness.
Structure:
Led by MPRO’s Statistical Analysis Resource Group
Director, includes:
-analysts from many of Michigan’s health plans
-representatives from hospitals, universities and the Michigan Health & Hospital
Association.
-Dr. Stephen Jencks, IHI Consultant, participates at times as well.
During bi-weekly meetings, the data workgroup has devised
both a data extract procedure and readmissions reporting
template.
Data extract procedure
Standardized program for pulling member-level data that
defines and categorizes readmissions.
Readmissions Reporting Template
Presents a wealth of readmissions information within a
single page layout.
Health plans extract member-level data for all acute care admissions from
their respective systems.
Admissions are sorted sequentially and categorized as ‘at risk’ or ‘not at risk’
of readmission.
Admissions not at risk of rehospitalization include:
Transfers to another inpatient facility (i.e., rehabilitation, skilled
nursing or hospice),
those ending in a patient’s death or in the patient leaving the hospital
against medical advice, and
admissions occurring within 30 days of the end of the data period.
Remaining admissions are considered at risk of readmission.
Data Elements of Interest
Unique Identification Number per
Patient
DRG (and contributing elements)
Patient Zip Code
Unique Identification Number per
Admission
Name of Hospital
Principal ICD-9 Diagnosis Code
Type of Bill
Hospital NPI number
Principal ICD-9 Procedure Code
Admission Date
Type of Admission
Product Group (commercial or
Medicaid/Medicare)
Discharge Date
Patient Gender
Follow-up Care
(inpatient/outpatient)
Discharge Status Number
Patient Age in Years
Enrollment Date
MSDRG (and contributing
elements)
Patient Date of Birth
Disenrollment Date
•Data are currently transmitted in summary form to
MPRO whom aggregates the information to populate
the final readmissions report template.
The next slide depicts the 2008 calendar year
data.
Disseminated reports include technical
specifications and a detailed narrative describing
data accompanied in the report.
Time Period: CY2008
Payers: HAP, Health Plus, Medicaid, Priority Health, Medicare, BCN, BCBSM
See Data Definitions for Column Descriptions
a
b
c
d
e
f
g
Type of Index Discharges
RA to the Same Hospital
RA to a Different Hospital
at Risk
AGE GROUP Admission
Reporting Template:
PRODUCT Line
N
Adult
Pediatric
Commercial
Post-neonatal
Neonatal
M
S
O
M
S
O
M
S
M
S
Total
Adult
Medicaid FFS
(managed care data not
shown for presentation
purposes)
Pediatric
Post-neonatal
Neonatal
M
S
O
M
S
O
M
S
M
S
Total
Medicare (FFS)
Adult
Total
Total by Age Group Adult
Pediatric
Post-neonatal
Neonatal
Grand Total
M
S
81,735
84,878
41,667
11,260
3,537
547
3,173
878
24,935
386
252,996
64,017
18,513
31,200
7,039
1,296
1,151
2,472
355
31,498
73
157,614
280,012
117,311
398,836
737,544
26,378
7,365
58,481
829,768
N
8,659
4,480
997
774
181
20
196
52
286
26
15,671
5,234
1,013
940
1,406
131
35
233
51
347
5
9,395
45,250
9,797
55,419
78,696
2,591
553
702
82,542
%
N
10.6%
5.3%
2.4%
6.9%
5.1%
3.7%
6.2%
5.9%
1.1%
6.7%
6.2%
8.2%
5.5%
3.0%
20.0%
10.1%
3.0%
9.4%
14.4%
1.1%
6.9%
6.0%
16.2%
8.4%
13.90%
10.7%
9.8%
7.5%
1.2%
9.9%
%
2,844
1,123
174
194
32
6
58
24
149
10
4,614
2,134
317
203
104
13
13
86
11
403
5
3,289
11,657
2,712
14,573
21,884
369
183
581
23,017
h
I
RA to Any Hospital
N
3.5%
1.3%
0.4%
1.7%
0.9%
1.1%
1.8%
2.7%
0.6%
2.6%
1.8%
3.3%
1.7%
0.7%
1.5%
1.0%
1.1%
3.5%
3.1%
1.3%
6.9%
2.1%
4.2%
2.3%
3.7%
3.0%
1.4%
2.5%
1.0%
2.8%
11,505
5,603
1,171
968
213
26
254
76
435
36
20,287
7,368
1,330
1,143
1,510
144
48
319
62
750
10
12,684
56,907
12,509
69,992
100,583
2,960
736
1,283
105,562
%
14.1%
6.6%
2.8%
8.6%
6.0%
4.8%
8.0%
8.7%
1.7%
9.3%
8.0%
11.5%
7.2%
3.7%
21.5%
11.1%
4.2%
12.9%
17.5%
2.4%
13.7%
8.1%
20.3%
10.7%
18.0%
13.6%
11.2%
10.0%
2.2%
8
12.7%
Information Otherwise
Unavailable
Data Description
These data are 30-day all-cause acute care readmissions by age and type of initial discharge. These rates are not adjusted or
standardized in any way; accordingly, rates are not intended for comparison of different facilities. Calculated rates include
both scheduled and unscheduled readmissions due to difficulties in defining and removing ‘scheduled’ readmissions.
Discharges that did not result in transfer to another acute care facility are counted in column ‘c’ and constitute the
denominator of the readmission rates listed in columns ‘e’, ‘g’ and ‘I’. Patients having left against medical advice are not
excluded from these data because they are potential targets of quality improvement interventions; this is expected to have
minimal impact, if any, on the reported rates. Same-day readmissions are counted as 30-day all-cause readmissions to
ensure a broad view of potential qualitiy improvement opportunities is provided. Medicaid & Medicare eligible
beneficiaries are reported by Medicaid. Above average numbers of patients having scheduled admissions within 30-days of
discharge (i.e., certain types of cancer patients, patients with gastrointestinal disorders scheduled for surgery later, etc. )
will increase the readmission rates reported here. We are working towards refining our efforts to remove scheduled
readmissions from future reports.
Reporting Template:
Brief Data Definitions (coloumn descriptions) - Expanded Definitions Available in 'Definitions Tab'
Age at time of discharge: Neonatal: birth <= Age <1 month; Post-neonatal: 1 month <= Age < 1 year;
a
Pediatric:1 year <= Age < 18 years; Adult: 18 years <= Age.
b Categorization of initial discharge following acute care admission; M=Medical, S=Surgical, O=Obstetric
c
Number of acute care discharges that were not transferred to other acute care centers & were not the result of the
patient leaving against medical advice.
d Number of acute care readmissions within 30-days of discharge where the patient was admitted to the hospital of
discharge
e Percent of acute care readmissions within 30-days of discharge where the patient was admitted to the hospital of
discharge
f
Number of acute care readmissions within 30-days of discharge where the patient was admitted at a hospital other than
the discharge hospital.
g Percent of acute care readmissions within 30-days of discharge where the patient was admitted to a hospital other than
the discharge hospital
9
h Total number of acute care readmissions within 30-days of discharge.
• Pilot reports have been disseminated.
•Plans are reporting aggregate data by calendar year quarter from 2006-2010
Initial reports due to be disseminated shortly will include a facility level
crude trend analysis
Statewide profiles will also be disseminated for comparative purposes
• We are drafting data use agreements to facilitate claim-level data sharing


•
Most plans have verbally agreed to share these data, although full approval has
yet to be received.
Some have already processed letters of commitment to do so
We are seeking external funding to engage the ReWaRD towards evaluation of
existing and newly implemented MI STA*AR interventions given that no other data
source in Michigan can support such analyses.
22670 Haggerty Road, Suite 100, Farmington Hills, MI 48335 ~ www.mpro.org
■
Allows for development of a comprehensive analytic file of
virtually all readmissions in Michigan.
► Facilitates
exploration of
♦ Risk standardization methods
♦ Methods of defining ‘preventable’ readmissions
♦ Evaluation of interventions (Provider and Payer level)
22670 Haggerty Road, Suite 100, Farmington Hills, MI 48335 ~ www.mpro.org
•The Rehospitalization Workgroup for Reporting Data is a subcommittee
tasked with facilitating multi-payer data sharing
■ While the original mission was to provide readmission reports to all
Michigan hospitals, it is now expanding to include evaluation of
readmission reduction initiatives through application of epidemiologic
methods.
•Barriers and other considerations include funding, HIPPA concerns,
and data access issues.
QUESTIONS?
22670 Haggerty Road, Suite 100, Farmington Hills, MI 48335 ~ www.mpro.org