EVALUATION OF THE QUALITY OF PRESENT-ON-ADMISSION CODING ScoreGradeHospitals (#) Hospitals (%) >95%A % >90% to 95%B % >80% to 90%C % >70% to 80%D % >70% or lowerF % Total Scored187100%

POA Screening Results for Sample Hospital Scores for High-Risk Medical Conditions ScreenScoreRange* Chronic medical conditions11 to 6 Acute and chronic components11 to 2 High prevalence of hospital-acquired21 to 4 High mortality when hospital-acquired31 to 5 * 1 = Best Result

POA Screening Results for Sample Hospital Scores for Elective Surgical Procedures ScreenScoreRange* Chronic medical conditions11 to 6 Acute and chronic components11 to 2 Relative contraindications31 to 5 Routine cases with long postop LOS21 to 2 * 1 = Best Result

POA Screening Results for Sample Hospital Scores for Labor and Delivery ScreenScoreRange* Chronic medical conditions11 to 6 Pre-labor obstetrical conditions31 to 6 Inconsistent coding of delivery11 to 4 Inconsistent coding of complications11 to 5 * 1 = Best Result

POA Screening Results for Sample Hospital Scores for General Screens and Aggregate Performance ScreenScoreRange* Miscoded exempt codes11 to 5 Miscoded non-exempt codes21 to 6 Miscoded principal diagnoses31 to 6 * 1 = Best Result Overall PerformanceScoreGrade All 15 screens83.5%C

Distribution of Hospital Total Scores ScoreGradeHospitals (#) Hospitals (%) >95%A % >90% to 95%B % >80% to 90%C % >70% to 80%D % >70% or lowerF % Total Scored187100%

COMPARISON OF RISK-ADJUSTED CLINICAL PERFORMANCE

Observed and Predicted Hospital Mortality Rates Congestive Heart Failure

Observed and Predicted Hospital Adverse Outcome Rates Congestive Heart Failure

Hospital Cost Congestive Heart Failure

Adverse Outcomes and Hospital Costs Congestive Heart Failure 13.82% $6, % $5,596

Observed and Predicted 30-Day Readmission Rate Congestive Heart Failure

DISTRIBUTION OF ADVERSE OUTCOMES

Distribution of Adverse Outcomes Congestive Heart Failure Chi-square = 1.85 N.S.

Asymmetrical Relationships of Observed and Predicted Outcomes Provide Insights about Clinical Effectiveness Overall Results Less Success with High Risk Balanced Less Success with Low Risk Superior Average Suboptimal Effect of Risk on Performance Superior Practice with Low Risk Cases Superior Practice Across All Risk Groups Superior Practice with High Risk Cases Special Problems with High Risk Cases Suboptimal Practice Across All Risk Groups Special Problems with Low Risk Cases Potential Problems with High Risk Cases No Particular Strengths or Weaknesses Potential Problems with Low Risk Cases

DYNAMIC PERSPECTIVE USING CONTROL CHARTS

Mortality Rate Congestive Heart Failure

Adverse Outcome Rate Congestive Heart Failure

Routine Cost Congestive Heart Failure

ASSESSMENT OF COMPARATIVE COST-EFFECTIVENESS Outcome (Best Providers) Input (Not A or C) Input (B † only in high risk) Comparison Outcome (Worst Providers) Conclusion (Best Practice = A with B † only in high risk) Cost-Effective Ineffective Risk Stratification Comparative Effectiveness

Comparative Effectiveness Traditional Comparative Effectiveness Analyses Congestive Heart Failure (First Line Therapy) Input A (+ Diuretics) Input A † (++ Diuretics) Comparative Effectiveness Conclusion (Best Practice = A+B † +C) Input B † (+ Vasodilators) Input B (No Vasodilators) Comparative Effectiveness Input C (No Pressors) Input C † (+ Pressors) Superior Inferior

Patient-Centered Comparative Cost-Effectiveness Analysis Congestive Heart Failure (First Line Therapy) Outcome (Best Providers) Comparative Effectiveness Input (Not A † or C † ) Input (B † only in high risk) Comparison Outcome (Worst Providers) Conclusion (Best Practice = A with B † only in high risk) Cost-Effective Ineffective Risk Stratification