Key result
Assessing 30-day readmissions with the PPR preventability component versus the CMS all-cause method altered outlier results for public reporting in 7% of hospitals and reimbursement in 30%.
Why the study?
Does the use of the PPR measure compared to the CMS all-cause measure change hospital readmission rates and outlier identification for AMI, HF, and pneumonia?
Observational
Yes
Does the use of the PPR measure compared to the CMS all-cause measure change hospital readmission rates and outlier identification for AMI, HF, and pneumonia?
Different methods of assessing 30-day readmissions (CMS all-cause vs. PPR preventability) result in clinically and financially significant differences in hospital performance profiling.
BACKGROUND: The Centers for Medicare and Medicaid Services' (CMS) all-cause readmission measure and the 3M Health Information System Division Potentially Preventable Readmissions (PPR) measure are both used for public reporting. These 2 methods have not been directly compared in terms of how they identify high-performing and low-performing hospitals. OBJECTIVES: To examine how consistently the CMS and PPR methods identify performance outliers, and explore how the PPR preventability component impacts hospital readmission rates, public reporting on CMS' Hospital Compare website, and pay-for-performance under CMS' Hospital Readmission Reduction Program for 3 conditions (acute myocardial infarction, heart failure, and pneumonia). METHODS: We applied the CMS all-cause model and the PPR software to VA administrative data to calculate 30-day observed FY08-10 VA hospital readmission rates and hospital profiles. We then tested the effect of preventability on hospital readmission rates and outlier identification for reporting and pay-for-performance by replacing the dependent variable in the CMS all-cause model (Yes/No readmission) with the dichotomous PPR outcome (Yes/No preventable readmission). RESULTS: The CMS and PPR methods had moderate correlations in readmission rates for each condition. After controlling for all methodological differences but preventability, correlations increased to >90%. The assessment of preventability yielded different outlier results for public reporting in 7% of hospitals; for 30% of hospitals there would be an impact on Hospital Readmission Reduction Program reimbursement rates. CONCLUSIONS: Despite uncertainty over which readmission measure is superior in evaluating hospital performance, we confirmed that there are differences in CMS-generated and PPR-generated hospital profiles for reporting and pay-for-performance, because of methodological differences and the PPR's preventability component.
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Mull et al. (2013) conducted an observational in Acute myocardial infarction, heart failure, and pneumonia. 3M Potentially Preventable Readmissions (PPR) measure vs. CMS all-cause readmission measure was evaluated on Hospital readmission rates and outlier identification for reporting and pay-for-performance. Assessing 30-day readmissions with the PPR preventability component versus the CMS all-cause method altered outlier results for public reporting in 7% of hospitals and reimbursement in 30%.
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