Calculating the frequency of serious reportable adverse events and hospital‐acquired conditions

The Centers for Medicare and Medicaid Services (CMS) mandated that Medicare Advantage Organizations (MAOs) begin reporting the number of serious reportable adverse events and hospital-acquired conditions received on Medicare claims. There are additional state mandates and health insurance plan requirements. The author provides an analysis of the reporting methodology and proposes an alternative approach using rate-based formulas that would yield information that is more useful.