1. AHRQ Quality Indicators Software Overview of Changes to v5.0 August 20, 2015

2. Webinar Instructions The webinar will be recorded and will be available on the AHRQ QI website. All participant lines are in listen-only mode throughout the presentation. You may submit webinar questions via the question feature at any time, however all questions will be answered during the Q&A session. Your question will only be visible to the moderators. 2

3. Today’s Presenters Mamatha Pancholi, MS, Project Officer, Quality Indicators, AHRQ Keith Bell, MPH, Health Data Decisions Expert Panel: Marguerite Barrett, MS, Truven Health Analytics (subcontractor) David Douglass, Health Data Decisions Vivek Kumar, Pantheon 3

4. Agenda 1.Overview of Changes 2.Coding updates 3.Methodology changes 4.Details of changes to key measures 5.Questions and closing 4

5. Overview of Changes Removal of E Codes POA Changes Code updates Removed Prediction Module Update to APR-DRG grouper Individual measure updates User feedback Expert review Listing in presentation not exhaustive 5

6. Coding Updates: E-Codes Facilitates ICD-10 compatibility Inconsistent reporting of E-codes Affected measures: ► PDI 01, 03, 13 ► PSI 05, 08, 15, 16, 21, 25, 26 E-codes minor aspect of indicator specification E-codes retained for “Self-inflicted injury” (exclusion for PSI 08) 6

7. Coding Updates: POA Use standard coding ► Y = Present on Admission ► W = Clinically undetermined ► POA exempt diagnoses assume POA = Y ► N = Not present on admission ► Anything else is considered not present POA = 1 is not present on admission 7

8. Coding Updates: APR-DRG APR-DRGs used in IQI Risk Adjustment Update to v32 ► Limited license download available ► Coding changes for FY2015 v32 may be applied to older datasets 8

9. Coding Updates: 2015 Revisions No changes due to ICD-9 Update MS-DRG and MDC ► Five new MS-DRG ► Updated corresponding MDC Minor revisions to measures (error, omission) Reminder: coding must be to required detail level 9

10. Coding Update: Populations County populations: 2014 Census Estimate Reference population: Combined 2012 SIDs Risk adjustment coefficients use new reference population ► Population changed, methodology did not except treatment of POA Data is more current 10

11. Methodology Changes: POA Measures may be run with or without POA ► Affects entire dataset Affects numerators for PSI, IQI, PDI Prediction module removed ► HCUP databases now have POA data available ► CMS requires POA data resulting in widespread use ► POA prediction module estimates were not always comparable to real data ► POA data is highly affected by coding variation Reference population selected for strong POA states 11

12. Methodology: Stratification Strata are now exclusive ► Version 4.5 allowed one discharge in multiple ► Risk adjustment and stratified rates affected Priority assigned in order of mortality rate Exclusion determined separately for each stratum Affected measures: ► IQI 02, 04, 09, 11, 17 ► PSI 04 12

13. Strata Identifiers IndicatorSASWinQI IQI 2AIQ2AIQI 201 IQI 2BIQ2BIQI 202 IQI 2CIQ2CIQI 203 IQI 4AIQ4AIQI 401 IQI 4BIQ4BIQI 402 IQI 4CIQ4CIQI 403 IQI 4DIQ4DIQI 404 IQI 11AIQ11AIQI 111 IQI 11BIQ11BIQI 112 IQI 11CIQ11CIQI 113 IQI 11DIQ11DIQI 114 IndicatorSASWinQI IQI 17AIQ17AIQI 171 IQI 17BIQ17BIQI 172 IQI 17CIQ17CIQI 173 PSI 4APS4APSI 42 PSI 4BPS4BPSI 43 PSI 4CPS4CPSI 44 PSI 4DPS4DPSI 45 PSI 4EPS4EPSI 46 13

14. Key Measure Changes: PSI PSI Composite weights updated PSI 09/27: Perioperative/Postoperative Hemorrhage or Hematoma ► Platelet disorders added to numerator exclusion ► Observed rate reduced PSI 10: Postoperative Physiologic and Metabolic Derangement Rate ► Diabetic complication codes removed from exclusions ► Resulting indicator now limited post-operative acute renal failure ► Chronic kidney failure exclusion restricted to Stage V or End Stage ► Observed rate increased 14

15. Key Measure Changes: PSI PSI 11: Postoperative Respiratory Failure Rate ► Removed exclusions for senility without psychosis ► Revised exclusion list for facial procedures o Removed gingivoplasty; added exclusions for facial bone and laryngo-tracheal operations ► Expanded conditions included in exclusions for lung cancer and esophageal surgery ► Slight decrease in observed rate, increase in expected 15

16. Key Measure Changes: IQI IQI Composite weights updated IQI 20: Pneumonia Mortality Rate ► Added Avian Influenza, H1N1, and Novel Influenza Virus to denominator specification ► Slight decrease in observed rate 16

17. Key Measure Changes: PQI PQI 10: Dehydration Admission Rate ► Restricted kidney failure POA exclusion to Stage V or End Stage ► Increase in observed rate 17

18. Key Measure Changes: PDI PDI Composite weights updated PDI 09: Postoperative Respiratory Failure ► Mirrors PSI 11 changes ► Removed exclusions for gingivoplasty and senility without psychosis ► Added denominator exclusions for facial bone and laryngo-tracheal operations ► Expanded conditions included in exclusions for lung cancer and esophageal surgery ► Slight decrease in observed rate 18

19. Questions and Answers Additional documentation referenced in this presentation: Rate Comparison, version 4.5 to 5.0 http://www.qualityindicators.ahrq.gov/Downloads/Software/V50/AHR Q_QI_Rate_Comparison_V45_V50.pdf http://www.qualityindicators.ahrq.gov/Downloads/Software/V50/AHR Q_QI_Rate_Comparison_V45_V50.pdf Coding Updates and Revisions ► PQI http://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V50/ChangeL og_PQI_v50.pdf http://www.qualityindicators.ahrq.gov/Downloads/Modules/PQI/V50/ChangeL og_PQI_v50.pdf ► IQI http://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/V50/ChangeL og_IQI_v50.pdf http://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/V50/ChangeL og_IQI_v50.pdf ► PSI http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50/ChangeL og_PSI_v50.pdf http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V50/ChangeL og_PSI_v50.pdf ► PDI http://www.qualityindicators.ahrq.gov/Downloads/Modules/PDI/V50/ChangeL og_PDI_v50.pdf http://www.qualityindicators.ahrq.gov/Downloads/Modules/PDI/V50/ChangeL og_PDI_v50.pdf 19

20. Thank You General Questions and Comments: AHRQ QI Technical Assistance Team QIsupport@ahrq.hhs.govQIsupport@ahrq.hhs.gov Documentation: http://www.qualityindicators.ahrq.gov/Modules/Default.aspx 20