Presentation is loading. Please wait.

Presentation is loading. Please wait.

Voluntary Hospital Public Reporting: PCI Readmission Collaboration between: The Centers for Medicare & Medicaid Services The American College of Cardiology.

Similar presentations


Presentation on theme: "Voluntary Hospital Public Reporting: PCI Readmission Collaboration between: The Centers for Medicare & Medicaid Services The American College of Cardiology."— 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 1

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 2

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) 3

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 4

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

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 6

7 Opportunity for Improvement CathPCI Registry® readmission rate: 11.9% Risk-standardized readmission rate ranges from 8.6% to 16.8% Distribution of CathPCI Registry ® Hospital 30-Day Risk- Standardized Readmission Rates following PCI (2010-2011 ) 7

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 8

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 9

10 Overarching Goal of This Effort Shifting and Narrowing the Curve 10

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 11

12 Timeline 12

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 13

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) –NCDR@acc.orgNCDR@acc.org 14

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 15

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

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) 17

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

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 19

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 20

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

22 Top 10 Reasons for Unplanned Readmission 22

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

24 Planned Readmission Definition 24

25 Top 10 Planned Readmissions (With stent) Top 10 Planned Procedures among Planned Readmissions Following PCI Discharge In 2010 (without stent) 25 Procedure CCS Procedure Description Number of Planned Procedures 45Percutaneous transluminal coronary angioplasty (PTCA)2161 48Insertion; revision; replacement; removal of cardiac pacemaker or cardioverter/defibrillator477 44Coronary artery bypass graft (CABG)300 49Other OR heart procedures126 62Other diagnostic cardiovascular procedures120 59Other OR procedures on vessels of head and neck102 51Endarterectomy; vessel of head and neck98 157Amputation of lower extremity55 52Aortic resection; replacement or anastomosis55 43Heart valve procedures48

26 Top 10 Planned Readmissions (Without stent) Top 10 Planned Procedures among Planned Readmissions Following PCI Discharge In 2010 (without stent) 26 Procedure CCS Procedure Description Number of Planned Procedures 44Coronary artery bypass graft (CABG)221 45Percutaneous transluminal coronary angioplasty (PTCA)169 48Insertion; revision; replacement; removal of cardiac pacemaker or cardioverter/defibrillator73 49Other OR heart procedures33 51Endarterectomy; vessel of head and neck15 99Other OR gastrointestinal therapeutic procedures14 59Other OR procedures on vessels of head and neck14 62Other diagnostic cardiovascular procedures13 84Cholecystectomy and common duct exploration12 43Heart valve procedures12

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 27

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 28

29 Worksheet 1 PCI Readmission Results CathPCI Registry® and Your Hospital’s Results on the 30-Day PCI Readmission Measure for the 2010-2011 Reporting Period **DO NOT TRANSMIT THIS FILE** This file contains personally identifiable information. Note: This data is for demonstration only 29 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%211031241201196

30 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 12345607/31/1108/04/11Unplanned410.308/13/118/20/11No1235 12356710/03/1010/08/10Unplanned410.210/30/1011/3/10YesN/A 12367807/17/1107/18/11Planned410.107/31/1108/01/11No1234 Worksheet 3 Patient Stay Information Your Hospital's Detailed Patient Stay Information for Readmissions Following PCI for the 2010-2011 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 30

31 Worksheet 5 Case Mix Profile Case Mix Profile for Your Hospital and All CathPCI Registry® Hospitals for the 2010-2011 Reporting Period **DO NOT TRANSMIT THIS FILE** This file contains personally identifiable information. Note: Simulated data for demonstration only 31 Risk FactorYour 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 25.022.9 Diabetes Status - Insulin Requiring Diabetes 10.013.1 GFR Not Measured 5.05.7 GFR < 30 5.0 30 ≤ GFR < 6030.0 32.8 60 ≤ GFR < 9045.0 44.7 GFR ≥ 90 15.011.7 Renal Failure - Dialysis 3.12.7 Hypertension 85.086.9 History of Tobacco Use14.213.6 Previous PCI 39.840.7 Presented with Heart Failure14.2 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 32

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 33

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 34

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 35 CCNStateHospital Name Participation in Voluntary Public Reporting Performance CategoryRSRR Lower 95% CI, Upper 95% CI Footnote 123456ALGeneral HospitalYesNo different than NCDR registry11.28.5, 14.0 222222CTCommunity HospitalYesBetter than NCDR registry7.15.0, 8.0 111111CTMemorial HospitalYesNo different than NCDR registry11.08.9, 12.4 333333TNCity HospitalYesWorse than NCDR registry14.013.0, 15.5 444444COGovernment HospitalYesNumber of cases too smallNot applicable 1 555555COUniversity HospitalYesNumber of cases too smallNot applicable 1 456789GAResearch HospitalYes---No cases 5 234567AZSpecialty HospitalNo--- 21 567891MERural HospitalNo--- 21

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) 36

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

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

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

40 Questions Type questions into chat window –Questions will be archived if we are unable to address them in the live webinar. Call in via audio line –(866) 574-8547 ID#: 20463925 –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. 40

41 ADDITIONAL SLIDES 41

42 Calculating risk-standardized rates 42

43 DescriptionOR (LOR, UOR) Intercept Age/101.26 (1.22, 1.29) Female1.29 (1.25, 1.34) BMI/50.88 (0.86, 0.90) CHF - Previous History1.31 (1.25, 1.38) Previous Valvular Surgery1.21 (1.07, 1.37) Cerebrovascular disease1.21 (1.15, 1.26) Peripheral Vascular Disease1.22 (1.16, 1.28) Chronic Lung disease1.40 (1.34, 1.46) Non-Insulin diabetes 1.12 (1.08, 1.18) Insulin diabetes 1.39 (1.31, 1.47) GFR: 0=Not measured1.04 (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 - Dialysis1.48 (1.32, 1.67) Hypertension1.08 (1.03, 1.14) History of Tobacco Use0.95 (0.93, 0.98) Previous PCI0.92 (0.89, 0.96) CHF - Current Status1.34 (1.27, 1.41) No MI on admission0.88 (0.83, 0.92) MI after 24 hours on admission1.11 (1.03, 1.19) EFP: 1=Not measured1.23 (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=Urgent1.39 (1.33, 1.45) PCI status: 3=Emergency1.46 (1.36, 1.57) PCI status: 4=Salvage1.71 (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) PCI Readmission Model 43

44 Worksheet 2: CathPCI Registry ® Distribution Distribution of Hospital 30-Day PCI Risk-Standardized Readmission Rates among CathPCI Registry ® Hospitals for the 2010-2011 Reporting Period (n = 1,197) **DO NOT TRANSMIT THIS FILE** This file contains personally identifiable information. DescriptionRisk-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 44

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 2010-2011 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 Failure4281616.0 13.6 Respiratory or Chest Symptoms 7862020.07.9 Ischemic Heart Disease414 1515.07.7 Acute Myocardial Infarction410 1010.06.2 Arrhythmia4275 5.0 Septicemia0385 5.0 2.7 Complication from Procedure 99611.02.6 Pneumonia48655.0 2.6 Gastrointestinal Hemorrhage578 11.02.5 Acute Renal Failure584 11.02.5 All Other Principal Discharge Diagnoses - 3131.046.8 45

46 Worksheet 6: Impact of Risk Factors Patient Risk Factor Odds Ratios and 95% Confidence Intervals for PCI Readmission Measure for the 2010 - 2011 Reporting Period **DO NOT TRANSMIT THIS FILE** This file contains personally identifiable information. Risk FactorOdds Ratio95% 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 1.16(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 Reference. GFR ≥ 90 1.06(1.01, 1.10) Renal Failure - Dialysis 1.45(1.35, 1.56) Hypertension 1.14(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 1.33(1.28, 1.38) 5 Additional Risk Factors (table truncated to fit slide ) 46


Download ppt "Voluntary Hospital Public Reporting: PCI Readmission Collaboration between: The Centers for Medicare & Medicaid Services The American College of Cardiology."

Similar presentations


Ads by Google