Vol. 48 No. 4Winter 2014-2015

Tarheel News The North Carolina Chapter’s News Magazine

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20 Tarheel News

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Feature ArticleThe QualityNet Hospital-Specific Report, Readmissions Penalties, & Your HospitalBy Michael Passanante, Director of Marketing, Besler Consulting

The CMS Hospital Readmissions Reduction Program (HRRP) was effective for Medicare discharges beginning on October 1, 2012 and reduces payments to IPPS hospitals with excess readmissions. In FY 2015, over 2,600 hospitals will receive lower Medicare payments totaling $428 million in penalties. This is an increase of over $200 million from FY 2014.

It is essentially impossible for hospitals to calculate their own readmission penalty. However, CMS provides each hospital with a Hospital-Specific Report (HSR), which is available via a hospital’s QualityNet secure portal. The report allows you to review the discharge-level data that is used by CMS to calculate the hospital’s Excess Readmission Ratio for each of the included measures. The file includes all hospital admissions for each of the readmission measures as well as those patients who were readmitted to either the hospital or another acute care hospital within 30 days of discharge. While the file is not all encompassing on its own, it does provide a good foundation for understanding where readmissions are coming from.

Several of our recent interactions with hospital financial professionals suggest that this data is not being actively analyzed by their organizations. There may be some good reasons for this.

1. Hospitals already manage a tremendous amount of data in-house and adding more is not a priority.

2. The HSR is a large MS Excel file and is cumbersome to manipulate in its raw form.

3. The beneficial insights that can be derived from the HSR may not be immediately clear.

What’s in the HSR?

QualityNet provides a comprehensive document that details all of the variables included in the HSR. You can find this document here: FY 2015 Hospital Readmissions Reduction Program Measure Information and Instructions Report. To summarize:

Your HSR contains your Hospital Readmissions Reduction Program results and all of the data used to calculate those results. This information is presented in 7 tabs, including:

• Workbook I Readmission

• Table 1: Hospital Results

• Table 2: Discharge-Level Information for the AMI Readmission Measure

• Table 3: Discharge-Level Information for the COPD

Readmission Measure

• Table 4: Discharge-Level Information for the HF Readmission Measure

• Table 5: Discharge-Level Information for the PN Readmission Measure

• Table 6: Discharge-Level Information for the THA/TKA Readmission Measure

The second tab in the HSR (Table 1: Hospital Results) presents for each readmission measure, the following information:

• Your hospital’s number of eligible discharges and number of unplanned readmissions. Table 1 only captures unplanned readmissions because only unplanned readmissions are used to calculate your hospital’s predicted and expected readmission rates as well as the Excess Readmission Ratio.

• Your predicted and expected readmission rates

• Your Excess Readmission Ratio

• The national observed readmission rate

For FY2015, Tables 2-6 each provides discharge-level data for all Part A Medicare fee-for-service (FFS) hospitalizations that occurred between July 1, 2010 and June 30, 2013, where the patient was 65 years or older at the time of admission and had a principal discharge diagnosis of AMI, COPD, HF, pneumonia or a procedure code for primary elective THA/TKA. These tables also include entries for all planned and unplanned readmissions that occurred within 30 days for any cause.

As you can see, there is a wealth of data included in the HSR. However, it does not include the physician responsible for each readmission, detailed diagnosis and procedure codes or financial data.

Like it or not, the HRRP is here to stay and will likely expand in scope over the coming years. Hospitals will need to become familiar with the measures used to determine readmissions penalty calculations if they are to improve patient care and minimize exposure to fines.

Michael Passanante, is the Director of Marketing & Communications for BESLER Consulting. Michael has over twenty years of experience leading marketing programs for global B-to-B organizations. Michael holds a BS in Marketing and MBA in Management both from Rutgers University.