1. The Nevada Partnership for Value Driven Healthcare So, What About the Data? Emily Sim, MS Healthcare Analyst HealthInsight

2. Data Source Center for Health Information Analysis (CHIA) at UNLV. Inpatient data submitted by all Nevada Hospitals Time Frame: June 1, 2009 – May 31, 2010

3. Data Inclusions All-Payer Acute Care and Critical Access Hospitals

4. Data Exclusions Children (<18 years) Rehab Admits (Billing MS-DRGs 945, 946) Transfers – coded as a single visit

5. Readmission Rate Calculation Readmission Rate = Number of Readmissions Number of Index Admissions

6. Definitions All hospital admissions are coded as one of the following: –Index Admission –Readmission –Not a Readmission

7. Definitions (cont.) Index Admission –First admission for each patient –The next admission occurring greater than 30 days after the discharge date of the previous Index Admission –The following cannot be Index Admissions An admission in which a patient dies An admission in which the patient leaves Against Medical Advice (AMA)

8. Definitions (cont.) Readmission –The first admission within 30 days of an Index Admission Not a Readmission –An admission that is neither an Index Admission nor a Readmission –An admission that occurs after a Readmission, but before another Index Admission

9. Example Admit DateDischarge DateType of Admission July 1, 2009July 3, 2009Index Admission July 12, 2009July 15, 2009Readmission July 30, 2009August 1, 2009Not a Readmission September 15, 2009September 20, 2009Index Admission

10. Baseline Readmission Rate Number of Readmissions Number of Index Admissions

11. Readmission Rates by Payer Payer Readmission Rate Medicare15% Nevada Medicaid13% Self-Pay8% Commercial Insurer12% Negotiated Discounts9% HMO8% Medicare HMO13%

12. Readmission Rates for Top Conditions Condition Readmission Rate Heart Failure20% COPD16% Septicemia16% Pneumonia12%

13. % of Total Readmissions Condition Readmission Rate % of Total Readmissions Heart Failure20%4% COPD16%4% Septicemia16%2% Pneumonia12%3%

14. Perhaps… Interventions that focus on the patient, not on the condition, will be most effective.

15. Rate Reduction Goal Reduce Readmissions by 10% Current Rate is 10.6% Goal is 9.5%