New Model Predicts Risk for Readmission to Hospital from Skilled Nursing Facilities

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Providigm's Research Team conducts groundbreaking research for the Medicare Payment Advisory Commission (MedPAC).

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We developed the first risk-adjusted measure of readmission to hospital following SNF discharge that was recommended by MedPAC to incentivize improved care transitions from SNFs.

The Hospital Readmission Reduction Program in the Affordable Care Act has already issued payment penalties to hospitals exceeding $227 million. Centers for Medicare & Medicaid Services (CMS) is now looking at other healthcare providers within the continuum of care to further reduce hospital readmissions, with Skilled Nursing Facilities (SNFs) topping the list. The Medicare Payment Advisory Commission (MedPAC) has funded Dr. Andrew Kramer and members of Providigm’s Research Team, the original developers of MedPAC’s SNF risk-adjusted readmission rates in 2006, to generate more up-to-date readmission rates for SNFs, and to add new SNF Quality Measures.

Highlights of Providigm’s research were reported in the MedPAC 2013 report to Congress (MedPAC March 2013, Chapter 8). Additionally, MedPAC recently posted the detailed Providigm Contractor Report on their website (Kramer et al 2013). This report provides methods and national results for all-cause and potentially avoidable hospital readmission rates during SNF stays and after SNF discharge.

“The research that we conducted for MedPAC this year was groundbreaking in several respects,” said Dr. Kramer. “First, we were able to develop a method to determine valid risk-adjusted readmission rates from SNFs to hospital at 30 days and 100 days from MDS 3.0 and claims can serve as a standard against which SNFs can compare their performance. Second, we developed the first risk-adjusted measure of readmission to hospital following SNF discharge that was recommended by MedPAC to incentivize improved care transitions from SNFs.”

The methods and results are publicly available. For example, the national average risk-adjusted all-cause 30-day readmission rate based on 1.8 million stays from 13,161 SNFs was 18.1%; however substantial variability was found among SNFs. The risk adjustment method used a weighted comorbidity index, a functional index, and selected additional patient characteristics. Precluded from the risk adjustment were services provided to SNF residents and prior hospitalization occurrences, both of which are recognized by the research and policy community to bias rate calculations.

Readmissions during the 30 days following SNF discharge averaged 13.5%. This represents the first time readmission rates following SNF discharge have been reported. This risk-adjusted rate was calculated using a method that took into account the unique characteristics of SNF discharges to home health agencies, long-term nursing home care, and those discharged to community without home care.

The analyses were based on more than 1.8 million stays in fiscal year 2011. Providigm uses the same methods in the abaqis® Quality Management System risk-adjusted readmission rate calculation. The risk-adjusted rates in abaqis are calculated in real time, using MDS 3.0 data. The Providigm methodology developed under the MedPAC contract provides a national standard based on transparent, federally funded research.

About Providigm

Providigm creates practical solutions, including the abaqis® Quality Management System, that health care providers can use every day to improve quality. We bring together scientific capability, clinical expertise and information technology in a single organization to solve the most pressing challenges that providers face. Our goal is to assist providers in meeting the evolving requirements of health care consumers and policy makers. For more information, visit http://www.providigm.com.

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Tracy Sollami
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