Risk-Standardised Hospital Visits Within 7 Days After Hospital Outpatient Surgery

Identifying Attributes

Care Settings
Care Transitions
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Hospital Outpatient Quality Reporting
Type of Quality Indicator
Outcome
IOM Quality Dimension
Effectiveness
Domain
Hospitalisation

Defining Attributes

Definition

Facility-level, post-surgical risk-standardised hospital visit ratio of the predicted to expected number of all-cause, unplanned hospital visits within 7 days of a same-day surgery at a hospital outpatient department among Medicare fee-for-service patients aged 65 years and older.

Numerator

All-cause, unplanned hospital visits occurring after discharge from the hospital outpatient department and within 7 days of the outpatient surgery.

Denominator

Eligible same-day surgeries or cystoscopy procedures with intervention performed at hospital outpatient departments for Medicare fee-for-service patients aged 65 years and older.

Exclusions

Surgeries for patients without continuous enrolment in Medicare fee-for-service Parts A and B in the 7 days after the surgery; Surgeries for patients who have an Emergency Department visit on the same day but billed on a separate claim, unless the Emergency Department visit has a diagnosis indicative of a complication of care; Surgeries that are billed on the same hospital claim as an Emergency Department visit and that occur on the same calendar day, unless the Emergency Department visit has a diagnosis indicative of a complication of care; Surgeries that are billed on the same hospital outpatient claim and that occur after the Emergency Department visit; Surgeries that are billed on the same outpatient claim as an observation stay; eye surgeries and same day surgeries performed concurrently with high-risk procedures.

Use of Risk Adjustment
Yes
Risk Adjustments

The risk-adjustment model has 25 patient-level variables, including age, clinical comorbidities, and indicators of surgical complexity. Adjusts for surgical procedural complexity using the Work Relative Value Unit of the procedure; and it classifies each surgery into an anatomical body system group using the Agency for Healthcare Research and Quality Clinical Classification System.

Stratifications

Data Attributes

Type of Data Collection
Administrative data
Data Collection Methods

Medicare administrative claims and enrolment data.

Frequency of Data Collection
Annually based on previous 24 months
Frequency of Data Collection in Days
365
Reporting Methods

Hospital Outpatient Quality Reporting (CMS and Providers) CMS Care Compare - Hospitals and Provider compare (Publicly reported) Contributes to Overall Hospital Quality Star Rating.

Reporting Frequency
Annually
Reporting Frequency in Days
365
Indicator Has Recommended Targets
No

Source and Reference Attributes

Link to Measurement Tools
Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
Yes
Australian Consortium for Aged Care Endorsed
No
Identified by PHARMA-Care Project
No
Upload Date
12 March 2025