The PRAXIS Nexus The PRAXIS Nexus

New CMS Proposed Rule: Potentially Preventable Hospital Readmission Measures for Post-Acute Care

Posted on November 19, 2015   |   
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In October 2015, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule that outlines new outcome measures related to preventable 30-day post-acute care readmissions to four types of facilities: skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCH) and home health agencies (HHA). These measures are required in the Improving Medicare PostAcute Care Transformation Act of 2014 (IMPACT Act) and the Protecting Access to Medicare Act of 2014 (PAMA).

CMS proposes six new outcome measures:

  1. 30-day potentially preventable readmissions following discharge from skilled nursing facilities, and
  2. Inpatient rehabilitation facilities
  3. Long-term care hospitals
  4. Home health agencies, as well as
  5. 30-day potentially preventable readmissions following discharge to SNFs, and
  6. Potentially preventable readmissions during an inpatient rehabilitation facility stay.

These readmissions rates, as with HRRP, are risk-adjusted at the organizational level to account for a variety of patient-level variables beyond the organization’s control, including but not limited to the patient’s age, sex, original reason for Medicare entitlement, comorbidities, primary diagnoses and number of hospital admissions in the year prior to post-acute care admission. Planned, scheduled readmissions would not be included in these calculations. Medicare fee-for-service inpatient claims and eligibility and enrollment data would be used in computing these totals.

Via environmental scan and analysis of existing claims data, CMS identified those conditions that, in the context of post-acute care, were most likely to be related to potentially preventable readmissions. These conditions were then divided using clinical judgment into several categories:

  • Inadequate management of chronic conditions
  • Inadequate management of infections
  • Inadequate management of other unplanned events
  • Inadequate prophylaxis
  • Inadequate injury prevention

COPD is included in the first of these categories; that is, COPD is included with other diagnoses thought to lead to avoidable readmissions due to inadequate management of the chronic condition. The proposed rule in its entirety, including risk adjustment calculations and planned readmission algorithms, can be found here. The public can comment on this proposed rule through December 1, 2015 by emailing comments to PPR@rti.org.

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