Presentation is loading. Please wait.

Presentation is loading. Please wait.

Voluntary Hospital Public Reporting: PCI Readmission

Similar presentations


Presentation on theme: "Voluntary Hospital Public Reporting: PCI Readmission"— Presentation transcript:

1 Voluntary Hospital Public Reporting: PCI Readmission
Collaboration between: The Centers for Medicare & Medicaid Services The American College of Cardiology Center for Outcomes Research and Evaluation

2 Agenda Introduction and Roles (next) Why Measure PCI Readmission?
Voluntary Public Reporting Overview Measure Overview Interpreting Your Results Hospital Compare Display Conclusion and Questions

3 Introduction and Roles
The American College of Cardiology (ACC) Centers for Medicare & Medicaid Services (CMS) Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE)

4 Agenda Introduction and Roles Why Measure PCI Readmission? (next)
Voluntary Public Reporting Overview Measure Overview Interpreting Your Results Hospital Compare Display Conclusion and Questions

5 PCI Procedures Common cardiac procedure
More than 600,000 performed in US Improves patient survival and quality of life

6 PCI Readmission Common, potentially preventable event
Major driver of cost in health care system Variation across hospitals suggests opportunity for improvement Evidence that hospitals can reduce readmission rates Project RED BOOST

7 Opportunity for Improvement
Distribution of CathPCI Registry® Hospital 30-Day Risk-Standardized Readmission Rates following PCI ( ) CathPCI Registry® readmission rate: 11.9% Risk-standardized readmission rate ranges from 8.6% to 16.8%

8 Agenda Introduction and Roles Why Measure PCI Readmission?
Voluntary Public Reporting Overview (next) Measure Overview Interpreting Your Results Hospital Compare Display Conclusion and Questions

9 Aims of Voluntary Public Reporting
Inform health care providers about opportunities to improve care Provide public with information on readmissions after PCI procedures without additional data collection burden to hospitals Promote investment in QI initiatives

10 Overarching Goal of This Effort
Shifting and Narrowing the Curve

11 Plans for Implementation
ACC, YNHHSC/CORE, and CMS provide measure results to CathPCI Registry® hospitals in March Hospitals can choose to voluntarily publicly report their measure results in the July 2013 release on Hospital Compare

12 Timeline

13 Purpose of Preview Period
Educate hospitals about measure in advance of voluntary public reporting Provide hospitals with results and data Help hospitals interpret results and data Explain how they can participate in voluntary public reporting Allow hospitals to ask questions

14 Preview Period Overview
NCDR website Hospitals have received: CathPCI Registry® Results Summary and Data File Instructions Hospital-Specific Data and Results Excel® File Publicly available resources: 2013 Measure Update Report, 2009 Technical Report, FAQs Data Release Consent Forms (to participate)

15 Agenda Introduction and Roles Why Measure PCI Readmission?
Voluntary Public Reporting Overview Measure Overview (next) Interpreting Your Results Hospital Compare Display Conclusion and Questions

16 Measure Summary Hospital risk-standardized 30-day readmission rate following PCI Results for CathPCI Registry® hospitals with at least one eligible PCI

17 Measure Design Medicare claims linked to CathPCI Registry® data
Risk model uses CathPCI Registry® data Readmissions identified using claims data Excludes planned readmissions Estimates hospital-level risk-standardized readmission rate (RSRR)

18 Inclusion criteria Medicare FFS patients aged 65+
Received PCI at a CathPCI Registry® hospital Discharged between 1/1/2010 and 11/30/2011

19 Exclusion Criteria Not enrolled in Medicare FFS at the time of the PCI
PCI performed >10 days after admission In hospital deaths Transfers out Patient discharged against medical advice. PCI without 30-day follow-up data PCI performed within 30 days of a prior PCI

20 Risk adjustment Accounts for differences in patient characteristics and comorbidities across hospitals Risk adjustment variables from CathPCI Registry® data Age Gender 18 additional variables

21 Outcome All-cause unplanned readmission Yes/No outcome
To any acute care hospital Within 30 days of discharge Yes/No outcome Attributed to hospital discharging the patient to a non-acute setting

22 Top 10 Reasons for Unplanned Readmission

23 Planned Readmissions Not a signal of hospital quality
Not counted in measure outcome Measure identifies planned readmissions using algorithm

24 Planned Readmission Definition

25 Top 10 Planned Readmissions (With stent)
Top 10 Planned Procedures among Planned Readmissions Following PCI Discharge In 2010 (without stent) Procedure CCS Procedure Description Number of Planned Procedures 45 Percutaneous transluminal coronary angioplasty (PTCA) 2161 48 Insertion; revision; replacement; removal of cardiac pacemaker or cardioverter/defibrillator 477 44 Coronary artery bypass graft (CABG) 300 49 Other OR heart procedures 126 62 Other diagnostic cardiovascular procedures 120 59 Other OR procedures on vessels of head and neck 102 51 Endarterectomy; vessel of head and neck 98 157 Amputation of lower extremity 55 52 Aortic resection; replacement or anastomosis 43 Heart valve procedures

26 Top 10 Planned Readmissions (Without stent)
Top 10 Planned Procedures among Planned Readmissions Following PCI Discharge In 2010 (without stent) Procedure CCS Procedure Description Number of Planned Procedures 44 Coronary artery bypass graft (CABG) 221 45 Percutaneous transluminal coronary angioplasty (PTCA) 169 48 Insertion; revision; replacement; removal of cardiac pacemaker or cardioverter/defibrillator 73 49 Other OR heart procedures 33 51 Endarterectomy; vessel of head and neck 15 99 Other OR gastrointestinal therapeutic procedures 14 59 Other OR procedures on vessels of head and neck 62 Other diagnostic cardiovascular procedures 13 84 Cholecystectomy and common duct exploration 12 43 Heart valve procedures

27 Agenda Introduction and Roles Why Measure PCI Readmission?
Voluntary Public Reporting Overview Measure Overview Interpreting Your Results (next) Hospital Compare Display Conclusion and Questions

28 Categorizing Hospital Performance
No different than CathPCI Registry® rate Worse than CathPCI Registry® rate Better than CathPCI Registry® rate Number of cases too small

29 Worksheet 1 PCI Readmission Results
CathPCI Registry® and Your Hospital’s Results on the 30-Day PCI Readmission Measure for the Reporting Period **DO NOT TRANSMIT THIS FILE** This file contains personally identifiable information. Note: This data is for demonstration only Your Hospital's Comparative Performance Your Hospital's Eligible Patient Stays (#) Your Hospital's Unadjusted Readmission Rate Your Hospital's RSRR (Lower 95% CI, Upper 95% CI) Unadjusted CathPCI Registry® Readmission Rate Number of Hospitals Better than CathPCI Registry® Readmission Rate Number of Hospitals No Different than CathPCI Registry® Readmission Rate Number of Hospitals Worse than CathPCI Registry® Readmission Rate Number of CathPCI Registry® Hospitals with too few cases (<25) CathPCI Registry® Hospitals Included in Measure No different than CathPCI Registry® rate 50  12.0% 11.5% (10.5%, 12.0%) 11.9% 21 1031 24 120 1196

30 Worksheet 3 Patient Stay Information
Your Hospital's Detailed Patient Stay Information for Readmissions Following PCI for the Reporting Period **DO NOT TRANSMIT THIS FILE OR ANY OF THE CONTENTS OF THIS TABLE** This file contains personally identifiable information. If you have questions about the information provided below please refer to Excel row numbers.  Note: Simulated data for demonstration only NCDR Patient ID Date of Index Procedure Date of Discharge for Index Procedure Readmission Type Principal Discharge Diagnosis for Readmission (ICD-9-CM Code) Date of Admission for Readmission Date of Discharge for Readmission Readmitted to your Hospital CCN of Readmitting Hospital 123456 07/31/11 08/04/11 Unplanned 410.3 08/13/11 8/20/11 No 1235 123567 10/03/10 10/08/10 410.2 10/30/10 11/3/10 Yes N/A 123678 07/17/11 07/18/11 Planned 410.1 08/01/11 1234

31 Worksheet 5 Case Mix Profile
Case Mix Profile for Your Hospital and All CathPCI Registry® Hospitals for the Reporting Period **DO NOT TRANSMIT THIS FILE** This file contains personally identifiable information. Note: Simulated data for demonstration only Risk Factor Your Hospital (%) CathPCI Registry® (%) Age (mean) 74.2  75.1 Female  39.5 40.0 Body Mass Index (mean)  27.3 27.0 History of Heart Failure  17.5 16.6 Previous Valvular Surgery  3.1 2.2 Cerebrovascular Disease  17.3 17.8 Peripheral Vascular Disease  16.3 16.8 Chronic Lung Disease  19.1 18.9 Diabetes Status - No Diabetes  65.0 64.0 Diabetes Status - Non-Insulin Requiring Diabetes  25.0 22.9 Diabetes Status - Insulin Requiring Diabetes  10.0 13.1 GFR Not Measured  5.0 5.7 GFR < 30 5.0 30 ≤ GFR < 60 30.0  32.8 60 ≤ GFR < 90 45.0  44.7 GFR ≥ 90  15.0 11.7 Renal Failure - Dialysis 2.7 Hypertension  85.0 86.9 History of Tobacco Use 14.2 13.6 Previous PCI  39.8 40.7 Presented with Heart Failure 14.2  13.3 (5 additional risk factors – table truncated to fit slide)

32 Agenda Introduction and Roles Why Measure PCI Readmission?
Voluntary Public Reporting Overview Measure Overview Interpreting Your Results Hospital Compare Display (next) Conclusion and Questions

33 About Hospital Compare
Official Medicare website Displays results on hospital quality measures CathPCI Registry® Hospitals can voluntarily publicly report PCI readmission results Must submit Data Release Consent Form (DCRF) by May 3 For July posting Can submit DRCF by beginning of August for October posting

34 Hospital Compare Display
The PCI Readmission Measure will appear on the Hospital Spotlight The PCI Readmission Measure can also be found using typical search function

35 Example: Hospital Compare Data Table
Hospital 30-Day Risk-Standardized Readmission Rates (RSRR) Following Percutaneous Coronary Intervention (PCI) Note: Simulated data for demonstration only Footnotes: 1: The number of cases is too small to reliably tell how well a hospital is performing. 5: No data are available from the hospital for this measure. 21: Data aren’t available for the voluntary public reporting of this measure CCN State Hospital Name Participation in Voluntary Public Reporting Performance Category RSRR Lower 95% CI, Upper 95% CI Footnote 123456 AL General Hospital Yes No different than NCDR registry 11.2 8.5, 14.0 222222 CT Community Hospital Better than NCDR registry 7.1 5.0, 8.0 111111 Memorial Hospital 11.0 8.9, 12.4 333333 TN City Hospital Worse than NCDR registry 14.0 13.0, 15.5 444444 CO Government Hospital Number of cases too small Not applicable 1 555555 University Hospital 456789 GA Research Hospital --- No cases 5 234567 AZ Specialty Hospital No 21 567891 ME Rural Hospital

36 Agenda Introduction and Roles Why Measure PCI Readmission?
Voluntary Public Reporting Overview Measure Overview Interpreting Your Results Hospital Compare Display Conclusion and Questions (next)

37 Data Release Consent Form
Click here for data release consent form

38 Dates to remember May 3 July 2013
Last opportunity to submit the Data Release Consent Form for July Hospital Compare posting July 2013 Results published on Hospital Compare

39 Resources Visit NCDR Website Email NCDR@acc.org
NOTE: Please do not or attach to s any patient identifiable information

40 Questions Type questions into chat window Call in via audio line
Questions will be archived if we are unable to address them in the live webinar. Call in via audio line (866) ID#: Please mute your computer speakers before dialing in. Once your question has been answered you will be disconnected. Any follow-up questions will require you to call in again or use chat. Remember to reactivate your speakers after your call is complete.

41 Additional Slides

42 Calculating risk-standardized rates

43 PCI Readmission Model Description OR (LOR, UOR) Intercept Age/10
Age/10 1.26 (1.22, 1.29) Female 1.29 (1.25, 1.34) BMI/5 0.88 (0.86, 0.90) CHF - Previous History 1.31 (1.25, 1.38) Previous Valvular Surgery 1.21 (1.07, 1.37) Cerebrovascular disease 1.21 (1.15, 1.26) Peripheral Vascular Disease 1.22 (1.16, 1.28) Chronic Lung disease 1.40 (1.34, 1.46) Non-Insulin diabetes 1.12 (1.08, 1.18) Insulin diabetes 1.39 (1.31, 1.47) GFR: 0=Not measured 1.04 (0.94, 1.15) GFR: 1="0<=GFR<30" 1.76 (1.61, 1.92) GFR: 2="30<=GFR<60" 1.17 (1.12, 1.22) GFR: 4="GFR>=90" 1.17 (1.09, 1.25) Renal Failure - Dialysis 1.48 (1.32, 1.67) Hypertension 1.08 (1.03, 1.14) History of Tobacco Use 0.95 (0.93, 0.98) Previous PCI 0.92 (0.89, 0.96) CHF - Current Status 1.34 (1.27, 1.41) No MI on admission 0.88 (0.83, 0.92) MI after 24 hours on admission 1.11 (1.03, 1.19) EFP: 1=Not measured 1.23 (1.18, 1.29) EFP: 2="0<=EFP<30" 1.45 (1.34, 1.57) EFP: 3="30<=EFP<45" 1.25 (1.18, 1.32) PCI status: 2=Urgent 1.39 (1.33, 1.45) PCI status: 3=Emergency 1.46 (1.36, 1.57) PCI status: 4=Salvage 1.71 (1.16, 2.52) pRCA/mLAD/pCIRC 1.04 (1.00, 1.09) pLAD 1.13 (1.07, 1.19) Left Main 1.16 (1.04, 1.30) Highest Pre-Procedure TIMI Flow: None 1.09 (1.02, 1.16)

44 Worksheet 2: CathPCI Registry® Distribution
Distribution of Hospital 30-Day PCI Risk-Standardized Readmission Rates among CathPCI Registry® Hospitals for the Reporting Period (n = 1,197) **DO NOT TRANSMIT THIS FILE** This file contains personally identifiable information.  Description Risk-Standardized Readmission Rate (%) 100% (Maximum RSRR) 16.8 99% 15.6 95% 14.3 90% 13.6 75% 12.8 50% (Median RSRR) 11.8 25% 11.0 10% 10.2 5% 9.7 1% 8.9 0% (Minimum RSRR) 8.6

45 Worksheet 4: Principal Discharge Diagnoses
Most Frequent Principal Discharge Diagnoses Associated with Unplanned Readmissions for all CathPCI Registry® Hospitals and Your Hospital for the Reporting Period **DO NOT TRANSMIT THIS FILE** This file contains personally identifiable information. Note: Simulated data for demonstration only Description of Principal Discharge Diagnosis of Readmission ICD-9-CM Code (To Third Digit) Your Hospital's Patient Stays (#) Your Hospital's Patient Stays (%) CathPCI Registry® Patient Stays (%) Heart Failure 428 16 16.0  13.6 Respiratory or Chest Symptoms 786 20 20.0 7.9 Ischemic Heart Disease 414  15 15.0 7.7 Acute Myocardial Infarction 410  10 10.0 6.2 Arrhythmia 427 5.0  5.0 Septicemia 038 2.7 Complication from Procedure 996 1 1.0 2.6 Pneumonia 486 5 Gastrointestinal Hemorrhage 578  1 2.5 Acute Renal Failure 584 All Other Principal Discharge Diagnoses -  31 31.0 46.8

46 Worksheet 6: Impact of Risk Factors
Patient Risk Factor Odds Ratios and 95% Confidence Intervals for PCI Readmission Measure for the Reporting Period **DO NOT TRANSMIT THIS FILE** This file contains personally identifiable information.  Risk Factor Odds Ratio 95% Confidence Interval Age 1.27 (1.25, 1.30) Female 1.25 (1.22, 1.29) Body Mass Index 0.89 (0.87, 0.91) History of Heart Failure 1.33 (1.29, 1.38) Previous Valvular Surgery 1.23 (1.14, 1.32) Cerebrovascular Disease 1.16 (1.12, 1.19) Peripheral Vascular Disease (1.13, 1.20) Chronic Lung Disease 1.51 (1.47, 1.56) Diabetes Status - No Diabetes Reference . Diabetes Status - Non-Insulin Requiring Diabetes 1.14 (1.11, 1.18) Diabetes Status - Insulin Requiring Diabetes 1.44 (1.39, 1.49) GFR Not Measured 1.01 (0.95, 1.07) GFR < 30 1.78 (1.68, 1.89) 30 ≤ GFR < 60 1.20 (1.17, 1.23) 60 ≤ GFR < 90 GFR ≥ 90 1.06 (1.01, 1.10) Renal Failure - Dialysis 1.45 (1.35, 1.56) Hypertension (1.09, 1.18) History of Tobacco Use 1.07 (1.03, 1.11) Previous PCI 0.94 (0.91, 0.96) Presented with Heart Failure (1.28, 1.38) 5 Additional Risk Factors (table truncated to fit slide )


Download ppt "Voluntary Hospital Public Reporting: PCI Readmission"

Similar presentations


Ads by Google