Hospital Wide All Cause Unplanned Readmission Measure (NQF #1789)

Transcript

1 Hospital -Wide All -Cause Unplanned Readmission Measure (NQF #1789) Communication and Care Coordination National Quality Strategy Domain: BPCI Advanced and Quality rewards Model The Center for Medicare and Medicaid Innovation’s (Innovation Center) BPCI Advanced healthcare providers for delivering services more efficiently, supports enhanced care coordination, and Hospitals and physicians should work collaboratively to achieve these goals, recognizes high quality care. which have potential to improve the BPCI Advanced Be neficiary experience and align to the CMS Quality es, Strategy goals of promoting effective communication and care coordination, highlighting best practic A goal of the BPCI Advanced Model is to promote seamless, and making care safer and more affordable. regardless of who is responsible patient a specific -centered care throughout each Clinical E pisode, for element of that care. Readmission Background on Hospital When a Medicar e beneficiary experiences a r eadmission after being discharged from the hospital, it is costly, disruptive to the patient and their family , and often preventable. While some readmissions are care and clear, monitored discharge to illness, appropriate transitional unavoidable due worsening procedures can reduce the risk of readmission. Rationale for Including the All Innovation Center -Cause Hospital Readmission in BPCI Advanced Measure Hospitals and their care teams collaborate to ensure that appropriate discharge planning, instructions, and follow up care are provided to patients to help reduce the risk of readmission. The Hospital- Wide All - has measure in multiple Federal programs including (HWR) Readmission Unplanned Cause been used also . It is and the Medicare Shared Savings Program (IQR) Program Hospital Inpatient Quality Reporting reported on the Hospital Compare website. pisode s Categorie Clinical E The HWR measure a pplies to all Clinical Episodes included in the BPCI Advanced M odel. Measure Specifications The ospital level at the h will be calculated Acute Care Hospital (ACH) performance on the HWR measure . For Physician Group Practices (PGPs), the for all Medicare beneficiaries included in the denominator measure will be calculated as specified, then weighted based on PGP Clinical Episode volume for each ed. he HWR measure is risk Performance on t BPCI Advanced ACH where an episode is triggered. adjust This patient Quality Reporting ( ) Program measure Wide All - IQR In Hospital the is also used in (Hospital- in the FY 2013 IPPS/LTCH PPS final rule Cause Unplanned Readmission measure (NQF #1789) adopted reported on ), which is 53528 beginning with the FY 2015 payment determination (77 FR 53521 through , 2019 1 February

2 Hospital Compare Model has been adjusted to . However, the reporting period for the BPCI Advanced st st through December 31 ) to align with the BPCI Advanced M odel. the calendar year (January 1 Denominator this hospital level measure is comprised The denominator all Medicare Fee -For -Service (FFS ) for of -federal acute ca re hospitals and are beneficiaries aged 65 years and older who are hospitalized at non Medicare participating acute c are hospital . These Medicare FFS beneficiaries must discharged alive from a Part A have 12 months of continuous Medicare admission . Index admission enrollment prior to the index he first admission, and the measure excludes index admissions for patients: refers to t admitted to Prospective Payment System (PPS) -exempt cancer hospitals; · without at least 30 days post -discharge enrollment in Medicare FFS ; · discharged against medical advice (AMA); · · admitted for primary psychiatric diagnoses; admitted for rehabilitation; or · admitted for medical treatment of cancer. · Numerator The numerator for this hospital level measure includes Medicare beneficiaries in the denominator who have a readmission for any cause , except for certain planned readmissions, within 30 days from the date If a has more than one unplanned admission of discharge from an eligible index admission. beneficiary any reason) within 30 days after discharge from the index admission, only one is counted as (f or a readmission. that readmissions do not have to Note at the same hospital location as the index be admission – a patient who is readmitted to any hospital will count as a readmission. Th is measure for a “yes ” or “no ” outcome of looks each admitted patient has a n unplanned whether readmission within 30 days. However, if the first readmission after discharge is considered planned, any subsequent unplanned readmission is not counted as an outcome for that index admission . Measure Submission and Calculation This measure is already collected by CMS under the Hospital IQR Program using Medicare Claims data and calculated using a performance period of three years. The BPCI Advanced Model uses only one calendar st st through December 31 year of data, from January 1 , for measur e calculation. This one year time period better aligns wit h the BPCI Advanced Model. This means that the BPCI Advanced measure results may differ from those that providers receive under the Hospital IQR Program and posted on Hospital Compare. from the Published Specifications Revisions The BPCI Advanced version of this measure follows a single calendar year rather than a three -year period. , 2019 2 February

3 Composite Quality Score The HWR measure is one component of the BPCI Advanced Composite Quality Score (CQS) calculation. The CQS is used to adjust a portion of any Positive Total Reconciliation Amount and any Negative Total Reconciliation Amount for Model Participants. The CQS adjustment will not adjust the Positive Total Reconciliation Amount down, nor will i t adjust the Negative Total Reconciliation Amount up by more than 10 percent. More information is available below. Other Resources Organization/Resource Website Address NQF #1789 http://www.qualityforum.org/QPS/1789 https://www.cms.gov/Medicare/Quality IQR Readmission Measure Initiatives - Patient - - Methodology Assessment - Instruments/HospitalQualityInits/Downloads/Hospital - Readmission Wide All - Cause - - - Updates.zip BPCI Advanced website - advanced https ://innovation.cms.gov/initiatives/bpci , 2019 3 February

Related documents

Programming Guide for ZPL II, ZBI 2, Set Get Do, Mirror, WML (en)

Programming Guide for ZPL II, ZBI 2, Set Get Do, Mirror, WML (en)

Programming Guide ZPL II ZBI 2 Set-Get-Do Mirror WML

More info »
FS Tools ES 50X UserGuide

FS Tools ES 50X UserGuide

FS-Tools Help File ES-50X ES-50XC Programming Guide

More info »
stelprdb5313366

stelprdb5313366

From: Beverley A Everson Beverley A Everson To: [email protected] ; Deborah K Sebesta ; [email protected] ; [email protected] ; [email protected] ; Cc: ; [email protected] ; [email protected] ; Mary M ...

More info »
PassIssuanceList

PassIssuanceList

FEDERAL RECREATION AREAS WHERE INTERAGENCY PASSES ARE ISSUED This list is not comprehensive and may include errors; some Federal recreation sites are only open part-time or may change what passes are ...

More info »
A Guide to Preparing Superfund Proposed Plans, Records of Decision, and Other Remedy Selection Decision Documents

A Guide to Preparing Superfund Proposed Plans, Records of Decision, and Other Remedy Selection Decision Documents

United States EPA 540-R-98-031 Solid Waste and Environmental Emergency Response OSWER 9200.1-23P Protection Agency PB98-963241 July 1999 Superfund A GUIDE TO PREPARING SUPERFUND PROPOSED PLANS, RECORD...

More info »
NHDES R WD 12 2

NHDES R WD 12 2

STATE OF NEW HAMPSHIRE 8 201 Section 305(b) and 303(d) Consolidated Assessment and Listing Methodology January 24 , 2019

More info »
PassIssuanceList

PassIssuanceList

FEDERAL RECREATION AREAS WHERE INTERAGENCY PASSES ARE ISSUED IMPORTANT! This list is not comprehensive and may include errors; some Federal recreation sites are only open part-time or may change what ...

More info »
thinkdsp

thinkdsp

Think DSP Digital Signal Processing in Python Version 1.0.9

More info »
reefs at risk revisited

reefs at risk revisited

inStitutionS ContriButing Reefs at Risk Revisited is a project of the World Resources Institute (WRI), developed and implemented in close collaboration with The Nature Conservancy (TNC), the WorldFish...

More info »
NWCG Airtanker Base Directory, PMS 507 , NFES 002537

NWCG Airtanker Base Directory, PMS 507 , NFES 002537

A publication of the National Wildfire Airtanker NWCG Coordinating Group Base Directory PMS 507 April 2019 NFES 002537

More info »
Soil Nail Manual   Reference Manual

Soil Nail Manual Reference Manual

U.S. Department of Transportation Publication No. FHWA-NHI- 14-0 07 FHWA GEC 0 Federal Highway Administration 07 February 2015 NHI Course No. 132085 Soil Nail Wa lls Reference Manual Developed followi...

More info »
Consumers Balance Time and Money in Purchasing Convenience Foods

Consumers Balance Time and Money in Purchasing Convenience Foods

United States Department of Agriculture Economic Consumers Balance Time and Money Research Service in Purchasing Convenience Foods Economic Research Report Number 251 Ilya Rahkovsky, Young Jo, and And...

More info »
625137

625137

2018-19 Nebraska All-Sports Record Book - Nebraska Communications Office -

More info »
doj final opinion

doj final opinion

UNITED STAT ES DIS TRICT COURT IC F OR THE D ISTR T OF CO LU M BIA UNITED STAT F AMERICA, : ES O : : la in t if f, P 99 No. on cti l A vi Ci : 96 (GK) -24 : and : TOBACCO-F UND, : REE KIDS ACTION F : ...

More info »
IT Asset Management

IT Asset Management

NIST SPECIAL PUBLICATION 1800 5 - IT Asset Management Includes Executive Summary Approach, Architecture, and Security Characteristics (B) ; (A); and How - To Guide s (C) Michael Stone Chinedum Irrechu...

More info »
Fannie Mae 2017 Form 10 K

Fannie Mae 2017 Form 10 K

UNITED ST ATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K O SECTION 13 OR 15(d) ANNUAL REPORT PURSUANT T ACT OF 1934 OF THE SECURITIES EXCHANGE For the fiscal year ended Decem...

More info »
paths more traveled final 9 28 15

paths more traveled final 9 28 15

United States Department of Agriculture Paths More Traveled: Predicting Future Recreation Pressures on America’s National Forests and Grasslands Donald B.K. English Pam Froemke A Forests on the Edge R...

More info »
What's It Worth? The Economic Value of College Majors

What's It Worth? The Economic Value of College Majors

Anthony P. Carnevale Jeff Strohl Michelle Melton

More info »
HB operating places

HB operating places

Rules • No hunting or harassing animals from a snowmobile, ATV or passenger vehicle. Hunting Exception: A qualified disabled hunter may obtain an “Oregon Disabilities Hunting and Fishing Permit” to hu...

More info »
web directory

web directory

2019 Telephone Directory National Interagency Fire Center 3833 South Development Avenue Boise, Idaho 83705 -5354 (208) 387 + 4 -digit extension Information (208) 387 -5512 Updated 5/ 201 9

More info »