1. Vicky A. Mahn-DiNicola RN, MS, CPHQ Vice President, Solutions Strategy
Midas+™ DataVision and 3M Potentially Preventable Readmission Enhancements Plus a special overview of the Hospital Readmission Reduction Program
Vicky A. Mahn-DiNicola RN, MS, CPHQ Vice President, Solutions Strategy
Midas+, Xerox Services

2. Potentially Preventable Readmissions Added in DataVision Web Application in May!
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

3. Report Parameters Allow You to Run Reports for 15 or 30 Day Readmissions
Palliative care code v66.7 when principal is a nonevent
Secondary are included in PPR methodology
PPR grouper has a setting that will exclude palliative care if it is POA. However, this code is exempt from POA reporting. Due to the variations in coding v66.7, and the use of the POA flag with this code, it was determined that it would be best to include this population in PPR reporting.
CDB Mean PPR Rate
The CDB mean PPR rate is determined by multiplying the number of the APR DRG encounters in each severity level by the PPR rate for that severity level. The sum for all four severity levels is divided by the total number of PPR At Risk cases (initial and only admissions) for the APR DRG (N=), and then multiplied by the mental health/age adjustment factors and then multiplied by 100 to state the result as a percentage.
Sum of (CDB encounters* PPR rate) for each subclass Mental Health/Age
* Adjustment * 100
Total PPR At Risk cases for the APR DRG in the CDB factors
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

4. Potentially Preventable Readmissions Added to APR DRG Service Line Profile
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

5. Readmissions Tab added to APR DRG Subclass Detail Report in May
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

6. More PPR Reports Coming in July
Adding Tab for Saved Readmissions
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

7. APR DRG Encounter Level Data
Now being provided to all DataVision clients
Separate license with 3M not required
Data planted back on your server in May 2012
Transitioning to monthly plant back in August so that data will be 2 months old instead of six
Standard Reports on server to drill down to patient and provider level potentially preventable data coming in August
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

8. And it just keeps getting better… More Cool Stuff Under Construction!
PPRs to be added to Physician Reports in the DataVision Web Application in October 2012
Potentially Preventable Complications to be added in January 2013 DataVision Web Update
PPC Server based reports for patient drill down planned for May 2013
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

9. Benefits of 3M™ Potentially Preventable Readmissions & Complications
Focuses attention on cases that you can affect through improved clinical and care management processes
Helps you understand the needs of your key populations
Trended PPR & PPC performance more sensitive to performance improvement initiatives
Optimally used with APR DRG LOS and Mortality findings to understand changing populations
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

10. Training Webinars for APR DRG PPRs
June 13, :30 am Pacific Time
June 15, :30 am Pacific Time
June 21, :30 pm Pacific Time
Register on the Midas+ Clients Only Website
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

11. Hospital Readmissions Reduction Program
Begins with October 1, 2012 discharges
Payments to hospitals will be reduced for excess 30-day readmissions following an index discharge
NQF #0505 Acute MI 30-day Risk Standardized Readmission
NQF #0330 Heart Failure 30-day Risk Standardized Readmission
NQF #0506 Pneumonia 30-day Risk Standardized Readmission
Excludes patients with in-hospital death, without at least 30 days post-discharge enrollment in Medicare FFS, discharged AMA or under the age of 65.
Only 1 readmission during 30 days following discharge from the initial hospitalization will count as a readmission for purposes of calculating adjustment factors
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

12. CMS Readmission Risk Adjustment Methodology
Patient demographic factors
Co-morbid diagnoses and indicators of frailty
Data source is from Medicare Part A and B claims (excluding Medicare Advantage) 12 months prior to and including the index admission
Discharges July 1, 2008 to June 30, 2011 will be used by CMS to calculate the excess readmission ratios used to determine payment in FY 2013
Midas+ can NOT replicate this measure
Methodology is available at:
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

13. Review of Proposed IPPS Rule CMS-1588-P Posted April 26, 2012
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

14. Hospital Readmissions Reduction Program Proposed Modification to Payment Calculation
The hospital’s DRG base payment will be modified by an “Adjustment Factor”
The “Adjustment Factor” will be the higher of either the “Ratio” or the “Floor” values (rounded to fourth decimal place)
Ratio = (aggregate payment for excessive readmissions)
(aggregate payment for all discharges)
Floor adjustment set at for FY 2013, for FY 2014 and for FY 2015 and subsequent fiscal years

15. Steps to Estimate Impact of Readmission Reduction Program at Your Hospital
Go to Hospital Compare and calculate your hospital’s excessive readmission ratio
Calculate aggregate payments for all discharges
Calculate aggregate payments for excess readmissions
Calculate your ratio and determine your readmission adjustment factor
Note that the data for the 3-year applicable period of July 1, 2008 to June 30, 2011
Has not been completed yet. CMS to post a review period before June 20, 2012
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

16. Step 1: Calculate your excessive readmission ratio for each population and retrieve your population volumes from Hospital Compare Website

17. Step #2: Calculate Aggregate Payments for All Discharges
(Base DRG payment x AMI volume) +
$6877 x 498 = $3,424,746
(Base DRG payment x CHF volume) +
$6877 x 671 = $4,614,467
(Base DRG payment x PN volume)
$6877 x 833 = $5,728,541
Aggregate payments for all discharges
$13,767,754
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

18. Step #3: Calculate Aggregate Payments for Excess Readmissions
(Base DRG payment x AMI volume) x (ERR – 1) =
(18.0 Hospital /19.8 National) – 1 =
$3,424,746 x = < 1 = NO EXCESS PAYMENTS
(Base DRG payment x CHF volume) x (ERR – 1) =
(24.9 Hospital /24.8 National ) – 1 = .0040
$4,614,467 x = $18, in Excess Payments
(Base DRG payment x PN volume) x (ERR -1) =
(18.8 Hospital /18.4 National) – 1 = .0217
$5,728,541 x = $124, in Excess Payments
Aggregate payments for excess readmissions
$142,916.07
You have to perform better than the national median in all three populations
in order to avoid a reduction in your DRG base payment rate
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

19. Step #4: Calculate your ratio
Ratio = 1 – (Aggregate payments for excess readmits / Aggregate payments for all discharges) Ratio = 1 – ($142,916.07/$13,767,754) 1 – Ratio = FY 2013 Floor value of is greater than ratio Hospital Readmission Adjustment Factor is Base Rate Decreased from $6,877 to $6,808.23
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

20. Tips for Preparing for Readmission Reduction Program
Excess readmission ratios used for Readmission Reduction Program are not identical to those posted on Hospital Compare for HIQR Program. Review confidential reports and patient level details about your hospital readmissions, which will be delivered to your secure QualityNet accounts by June 20, 2012 (30-day review period)
Only 34.5% of American hospitals will have no adjustment. Have your CFO and Quality Officer review the proposed rule in detail and comment, comment, comment to CMS on or before June 25, 2012
Review readmission patterns for your hospital wide and total knee and hip populations NOW to determine impact on your organization because these populations may be added to the Hospital Inpatient Quality Program
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

21. Proposed New Claims-Based Measures for FY 2015 Payment Determination
Hip/Knee Readmission: Hospital-Level 30-day All-Cause Risk Standardized Readmission Rate following elective primary total hip and knee arthroplasty NQF #1551
2008 Medicare FFS claims data show rates range from 3.06 to percent (median 6.06%)
Repeat hip/knee arthoplasty in 30 days excluded
Risk adjusted similar to AMI, HF and PN readmission metrics
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona

22. Proposed New Claims-Based Measures for FY 2015 Payment Determination
Hospital Wide Readmission
All-Cause readmissions within 30 days of discharge
Single summary score derived from five specialties: medicine, surgery and gynecology, cardiorespiratory, cardiovascular and neurology
Exclusions include planned procedures, cancer and psychiatric conditions
Pending NQF endorsement
20% of all Medicare beneficiaries are re-hospitalized within 30 days of discharge
Preventable readmissions estimated from 12 to 76 percent
If national rates could be lowered to levels achieved by top performing regions $1.9 billion saved annually
There is a wide list of procedures that have been identified as planned depending upon the discharge condition of the index encounter, such as laminectomy, nephrectomy, hernia repairs etic. which are being proposed as exclusions. The list is not likely inclusive of all possibilities but is quite extensive. There is also a list of conditions considered as acute or complications of care, such as AMI, cardiac dysrhythmias, septicemia, fracture and many more that will qualify a patient a “unplanned” readmission.
Measure specifications can be found on NQF Website at
Maintenance.aspx
21st Annual Midas+ User Symposium • May 20–23, 2012 • Tucson, Arizona