Performance Measurement Workgroup Changes for Readmission Rate
Performance Measurement
Workgroup
12/16/2015
Update on CMMI Waiver Target Metric
HSCRC and CMMI have agreed to Version 5 of readmission
measure, which includes the following change:
Exclusion of stays where a psychiatric condition is listed as a primary
diagnosis in claims for the index admission or readmission.
Exclusion of stays where a rehabilitation condition is listed as a
primary diagnosis in claims for the index admission or readmission.
Refining the definition of stays and transfers in the readmissions
measures to treat all same-day and next-day claims as continuous
stays or transfers, except where:
The second admission occurs at the same hospital but has a diagnosis
code that differs from the index admission;
The second admission occurs the next day at the same hospital, either
with the same or a different diagnosis code.
Comparison V4 and V5
Readmission Reduction Incentive
Policy Updated for RY2018
Readmission Measure Changes
Revise Transfer Logic:
All same and next day admissions (determined by admit and
discharge date) are considered a transfer
Modify Planned Admission logic for ICD-10
P
r
o
j
e
c
t
i
n
g
N
a
t
i
o
n
a
l
F
F
S
R
a
t
e
s
In support of RRIP Improvement
Target Setting
Matthew Sweeney
December 16
th
, 2015
Overview
•
P
r
o
j
e
c
t
n
a
t
i
o
n
a
l
M
e
d
i
c
a
r
e
F
F
S
r
e
a
d
m
i
s
s
i
o
n
r
a
t
e
–
P
r
o
v
i
d
e
s
“
g
o
a
l
p
o
s
t
s
”
t
o
a
s
s
e
s
s
s
t
a
t
e
’
s
p
r
o
g
r
e
s
s
–
D
e
v
e
l
o
p
F
F
S
i
m
p
r
o
v
e
m
e
n
t
t
a
r
g
e
t
s
f
o
r
s
t
a
t
e
(
b
y
y
e
a
r
)
–
S
u
p
p
o
r
t
s
d
e
v
e
l
o
p
m
e
n
t
o
f
a
l
l
-
p
a
y
e
r
i
m
p
r
o
v
e
m
e
n
t
t
a
r
g
e
t
s
•
D
o
w
n
w
a
r
d
t
r
e
n
d
i
n
n
a
t
i
o
n
a
l
F
F
S
r
a
t
e
h
a
s
s
l
o
w
e
d
–
C
u
m
u
l
a
t
i
v
e
r
e
d
u
c
t
i
o
n
C
Y
2
0
1
1
–
2
0
1
3
:
-
5
.
6
%
–
C
u
m
u
l
a
t
i
v
e
r
e
d
u
c
t
i
o
n
C
Y
2
0
1
3
–
2
0
1
5
:
-
0
.
6
%
•
A
p
p
l
y
v
a
r
i
e
t
y
o
f
m
e
t
h
o
d
s
t
o
p
r
e
d
i
c
t
n
a
t
i
o
n
a
l
r
e
a
d
m
i
s
s
i
o
n
r
a
t
e
t
h
r
o
u
g
h
C
Y
2
0
1
8
–
D
e
v
e
l
o
p
r
a
n
g
e
o
f
p
r
e
d
i
c
t
e
d
v
a
l
u
e
s
–
A
c
c
o
u
n
t
f
o
r
u
n
c
e
r
t
a
i
n
t
y
i
n
h
e
r
e
n
t
i
n
a
n
y
o
n
e
p
r
o
j
e
c
t
i
o
n
•
D
e
v
e
l
o
p
F
F
S
i
m
p
r
o
v
e
m
e
n
t
t
a
r
g
e
t
s
u
n
d
e
r
v
a
r
i
o
u
s
s
c
e
n
a
r
i
o
s
Data and Methods
•
D
a
t
a
:
–
M
o
n
t
h
l
y
M
e
d
i
c
a
r
e
F
F
S
n
a
t
i
o
n
a
l
r
a
t
e
–
J
a
n
u
a
r
y
2
0
1
1
t
o
J
u
n
e
2
0
1
5
–
V
e
r
s
i
o
n
V
o
f
t
h
e
m
e
a
s
u
r
e
s
p
e
c
i
f
i
c
a
t
i
o
n
s
•
P
r
o
j
e
c
t
i
o
n
m
o
d
e
l
s
:
–
A
R
I
M
A
a
n
d
L
O
E
S
S
•
Use historical data to project future readmission rates
•
Decompose and model seasonality and trend separately
•
Yields projected rate and 95 percent confidence intervals
–
T
w
o
-
y
e
a
r
m
o
v
i
n
g
a
v
e
r
a
g
e
•
A
l
l
m
e
t
h
o
d
s
m
a
k
e
s
i
m
i
l
a
r
p
r
e
d
i
c
t
i
o
n
s
f
o
r
r
a
t
e
s
i
n
C
Y
2
0
1
6
,
2
0
1
7
,
a
n
d
2
0
1
8
LOESS Projections
Moving Averages
Two-Year Moving Average Projection
Summary of National Projections
•
M
o
v
i
n
g
a
v
e
r
a
g
e
,
A
R
I
M
A
,
L
O
E
S
S
a
l
l
i
n
d
i
c
a
t
e
n
o
t
r
e
n
d
i
n
n
a
t
i
o
n
a
l
r
a
t
e
–
P
r
o
j
e
c
t
e
d
r
a
t
e
i
s
1
5
.
4
%
•
S
h
o
u
l
d
w
e
b
e
l
i
e
v
e
i
t
?
–
M
o
d
e
l
p
r
o
j
e
c
t
i
o
n
s
b
a
s
e
d
o
n
r
e
c
e
n
t
l
a
c
k
o
f
t
r
e
n
d
–
C
o
u
l
d
p
r
e
-
2
0
1
4
r
e
d
u
c
t
i
o
n
r
e
-
o
c
c
u
r
?
•
S
c
e
n
a
r
i
o
1
:
t
r
e
n
d
r
e
m
a
i
n
s
f
l
a
t
t
h
r
o
u
g
h
2
0
1
8
(
m
o
d
e
l
p
r
e
d
i
c
t
i
o
n
s
)
•
S
c
e
n
a
r
i
o
2
:
a
s
s
u
m
e
a
v
e
r
a
g
e
d
e
c
r
e
a
s
e
o
b
s
e
r
v
e
d
s
i
n
c
e
2
0
1
1
w
i
l
l
o
c
c
u
r
i
n
f
u
t
u
r
e
y
e
a
r
s
Scenario 2: Assume Average Change Since 2011
Setting FFS Improvement Targets
•
I
n
h
e
r
e
n
t
u
n
c
e
r
t
a
i
n
t
y
i
n
p
r
o
j
e
c
t
e
d
n
a
t
i
o
n
a
l
r
a
t
e
•
P
r
e
s
e
n
t
F
F
S
i
m
p
r
o
v
e
m
e
n
t
t
a
r
g
e
t
s
b
a
s
e
d
o
n
t
h
r
e
e
n
a
t
i
o
n
a
l
p
r
o
j
e
c
t
i
o
n
e
s
t
i
m
a
t
e
s
:
–
O
b
s
e
r
v
e
d
a
n
n
u
a
l
c
h
a
n
g
e
(
C
Y
1
5
o
v
e
r
C
Y
1
4
)
–
L
o
w
e
r
b
o
u
n
d
o
f
s
t
a
t
i
s
t
i
c
a
l
p
r
o
j
e
c
t
i
o
n
s
•
Incorporate uncertainty in projections
–
“
S
c
e
n
a
r
i
o
2
”
(
a
s
a
”
w
o
r
s
t
c
a
s
e
”
s
c
e
n
a
r
i
o
)
RY2018 RRIP Rate Targets
FFS Reduction Targets Across Approaches
* Cumulative reductions are calculated over the CY2013 Maryland FFS rate of 16.61%.
** Observed Rate of Change refers to applying observed rate of change in CY2015 (over CY2014) for future years and setting Maryland
targets accordingly. The LOESS-Lower Bound approach uses the lower bound of the 95
th
confidence interval around the predicted
CY2018 national rate, and spreads the required cumulative reduction equally over the years. The “Scenario 2” approach assumes a
CY2018 national rate that is based on projecting the average improvement observed from 2011 through June 2015 to future time
periods.
Update on the Performance Measurement Workgroup's adjustments to the readmission measure, including exclusions for psychiatric and rehabilitation conditions, refining stays and transfers, and comparison of Version 4 and Version 5 metrics in Maryland. The Readmission Reduction Incentive Policy has been updated for RY2018, with changes in transfer logic and planned admission criteria. Projected national FFS rates and Medicare readmission trends are analyzed with improvement targets set for state progress assessment.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
Performance Measurement Workgroup 12/16/2015
Update on CMMI Waiver Target Metric HSCRC and CMMI have agreed to Version 5 of readmission measure, which includes the following change: Exclusion of stays where a psychiatric condition is listed as a primary diagnosis in claims for the index admission or readmission. Exclusion of stays where a rehabilitation condition is listed as a primary diagnosis in claims for the index admission or readmission. Refining the definition of stays and transfers in the readmissions measures to treat all same-day and next-day claims as continuous stays or transfers, except where: The second admission occurs at the same hospital but has a diagnosis code that differs from the index admission; The second admission occurs the next day at the same hospital, either with the same or a different diagnosis code. 2
Comparison V4 and V5 Maryland National Percentage Point Difference from V4 Percentage Point Difference from V4 Gap Readmission Rate Readmission Rate between MD and Nation Admissions Readmissions Admissions Readmissions 9,184,776 1,449,745 15.78% 207,550 35,449 17.08% V4 1.30% V5 Proposed (includes transfer adjustments as well) V5 Psych Exclusion Only V5 Rehab Exclusion Only 9,007,811 9,040,487 9,176,271 1,385,896 1,411,002 1,448,983 15.39% 15.61% 15.79% 196,369 198,620 202,902 32,618 32,912 34,954 16.61% 16.57% 17.23% -0.39% -0.17% 0.01% -0.47% -0.51% 0.15% 1.22% 0.96% 1.44% 3
Readmission Reduction Incentive Policy Updated for RY2018 4
Readmission Measure Changes Revise Transfer Logic: All same and next day admissions (determined by admit and discharge date) are considered a transfer Modify Planned Admission logic for ICD-10 5
Projecting National Projecting National FFS FFS Rates Rates In support of RRIP Improvement Target Setting December 16th, 2015 Matthew Sweeney
Overview Project national Medicare FFS readmission rate Provides goalposts to assess state s progress Develop FFS improvement targets for state (by year) Supports development of all-payer improvement targets Downward trend in national FFS rate has slowed Cumulative reduction CY2011 2013: -5.6% Cumulative reduction CY2013 2015: -0.6% Apply variety of methods to predict national readmission rate through CY2018 Develop range of predicted values Account for uncertainty inherent in any one projection Develop FFS improvement targets under various scenarios 7 7
Data and Methods Data: Monthly Medicare FFS national rate January 2011 to June 2015 Version V of the measure specifications Projection models: ARIMA and LOESS Use historical data to project future readmission rates Decompose and model seasonality and trend separately Yields projected rate and 95 percent confidence intervals Two-year moving average All methods make similar predictions for rates in CY2016, 2017, and 2018 8 8
Moving Averages 24-month moving average 0.161 0.16 0.159 0.158 0.157 0.156 0.155 0.154 0.153 2012.5 2013 2013.5 2014 2014.5 2015 2015.5 2016 10 10
Two-Year Moving Average Projection Projection based on 24-month moving average 0.161 0.16 0.159 0.158 0.157 0.156 0.155 0.154 0.153 2012 2013 2014 2015 2016 2017 2018 2019 2020 11 11
Summary of National Projections Moving average, ARIMA, LOESS all indicate no trend in national rate Projected rate is 15.4% Should we believe it? Model projections based on recent lack of trend Could pre-2014 reduction re-occur? Scenario 1: trend remains flat through 2018 (model predictions) Scenario 2: assume average decrease observed since 2011 will occur in future years 12 12
Scenario 2: Assume Average Change Since 2011 Projected 4-quarter moving average 0.164 0.162 0.16 0.158 0.156 0.154 0.152 0.15 0.148 0.146 0.144 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 13 13
Setting FFS Improvement Targets Inherent uncertainty in projected national rate Present FFS improvement targets based on three national projection estimates: Observed annual change (CY 15 over CY 14) Lower bound of statistical projections Incorporate uncertainty in projections Scenario 2 (as a worst case scenario) 14 14
RY2018 RRIP Rate Targets CMMI Measure Version V MD- US Difference Nation MD Percent Change in Rate of Readmits Percent Change in Rate of Readmits % Readmissions % Readmissions % Readmits c1 c2 c3 c4 c5 11.54% 10.49% 7.99% 6.42% CY2011 CY2012 CY2013 CY2014 L1 L2 L3 L4 16.29% 15.76% 15.38% 15.47% 18.17% 17.41% 16.61% 16.46% -3.24% -2.41% 0.57% -4.15% -4.61% -0.89% CY 2015 YTD June CY 2015 Projected 15.38% 15.37% -0.63% -0.63% 16.02% 15.87% -3.59% -3.59% 4.18% 3.25% Targets for Future Years CY2016 CY2017 CY2018 L5 L6 L7 15.28% 15.18% 15.09% -0.63% -0.63% -0.63% 15.61% 15.35% 15.09% -1.67% -1.68% -1.69% 2.17% 1.08% 0.00% 15 15
FFS Reduction Targets Across Approaches Annual FFS Targets Year 2016 2017 2018 Use Observed Rate of Change 15.61% 15.35% 15.09% LOESS-Lower Bound 15.64% 15.33% 15.02% "Scenario 2" 15.09% 14.85% 14.61% Cumulative Reduction Targets (FFS) Year Use Observed Rate of Change 2016 2017 2018 LOESS-Lower Bound -5.84% -7.72% -9.55% "Scenario 2" -9.18% -10.62% -12.07% -6.04% -7.62% -9.18% * Cumulative reductions are calculated over the CY2013 Maryland FFS rate of 16.61%. ** Observed Rate of Change refers to applying observed rate of change in CY2015 (over CY2014) for future years and setting Maryland targets accordingly. The LOESS-Lower Bound approach uses the lower bound of the 95th confidence interval around the predicted CY2018 national rate, and spreads the required cumulative reduction equally over the years. The Scenario 2 approach assumes a CY2018 national rate that is based on projecting the average improvement observed from 2011 through June 2015 to future time periods. 16 16
CY 2015 National vs Maryland Readmission Trends 0.175 0.17 0.165 0.16 0.155 0.15 0.145 0.14 Jan Feb Mar Apr May Jun Jul Aug National MD 17
CY 2014 National vs Maryland Readmission Trends 0.175 0.17 0.165 0.16 0.155 0.15 0.145 0.14 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec National MD 18
