An inpatient rehabilitation facility's (IRF's) risk-standardised rate of Medicare fee-for-service (FFS) patients who are discharged to the community following an IRF stay.

The numerator is the risk-adjusted estimate of the number of patients/residents who are discharged to the community, do not have an unplanned readmission to an acute care hospital or long-term care hospital (LTCH) in the 31-day post-discharge observation window, and who remain alive during the post-discharge observation window. This estimate starts with the observed discharges to community, and is risk adjusted for patient/resident characteristics and a statistical estimate of the facility effect beyond case mix. Discharge to community is based on the Patient Discharge Status Code from the IRF claim. Discharge to community is defined as discharge to home/self-care with or without home health services. Patient discharge status codes 81 and 86 are intended for use on acute care claims only. However, because these codes have sometimes been reported on post-acute care (PAC) claims, we include them in our definition of community to credit the PAC provider for discharging the patient to a community setting.

The denominator for the discharge to community measure is the risk-adjusted expected number of discharges to community. This estimate includes risk adjustment for patient/resident characteristics with the facility effect removed. The "expected" number of discharges to community is the predicted number of risk-adjusted discharges to community if the same patients/residents were treated at the average facility appropriate to the measure. The regression model used to calculate the denominator is developed using all non-excluded facility stays in the national data. The denominator is computed in the same way as the numerator, but the facility effect is set at the average.

• Age under 18 years • No short-term acute care stay within the 30 days preceding an IRF, skilled nursing facility (SNF), or LTCH admission • Discharges to psychiatric hospital • Discharges against medical advice • Discharges to disaster alternative care sites or federal hospitals • Discharges to court/law enforcement • Patients/residents discharged to hospice and those with a hospice benefit in the post-discharge observation window • Patients/residents whose prior short-term acute care stay was for non-surgical treatment of cancer • Patients/residents whose prior short-term acute care stay was for non-surgical treatment of cancer • Post-acute stays that end in transfer to the same level of care • Post-acute stays with claims data that are problematic (e.g., anomalous records for stays that overlap wholly or in part, or are otherwise erroneous or contradictory) • Planned discharges to an acute or LTCH setting • Medicare Part A benefits exhausted • Patients/residents who received care from a facility located outside of the United States (US), Puerto Rico or a US territory • Swing Bed Stays in Critical Access Hospitals (SNF setting only).

Risk adjustment variables : 1. Age and sex groups. 2. End stage renal disease (ESRD) or disability as original reason for entitlement. 3. Principal diagnosis (Clinical Classifications Software (CCS) groups) from the prior acute stay in the past 30 days. The principal diagnosis codes from the prior acute claim are grouped clinically using the CCS groupings developed by the Agency for Healthcare Research and Quality (AHRQ). 4. IRF case-mix groups. 5. Surgical procedure categories (if present) based on the prior acute stay in the past 30 days. The procedures are grouped using the CCS groupings of procedures developed by AHRQ. 6. Dialysis in prior acute stay where ESRD not indicated. 7. Indicator for ESRD status. 8. Length of prior acute hospital stay in days, for patients/residents whose prior acute stay was in a non-psychiatric hospital (categorical variables are used to account for nonlinearity); indicator of prior psychiatric hospital stay for patients/residents whose prior acute stay was in a psychiatric hospital. 9. Number of intensive/cardiac care days during the prior acute stay (in the LTCH model). 10. Ventilator use during the post-acute stay (in the LTCH and SNF models). 11. Comorbidities (Hierarchical Condition Categories) (based on prior acute stay in the past 30 days or based on a one year look back, depending on the specific comorbidity). Comorbidities are based on secondary diagnoses in claims and are clustered using the Hierarchical Condition Categories (HCC) groups used by the Centers for Medicare & Medicaid Services (CMS). This measure was developed using Version 21 of the HCCs; when the measure is calculated using data post ICD-10 transition, we intend to use Version 22 of the HCCs. 12. Number of prior acute hospital discharges in the past year, not including the hospitalisation in the 30 days prior to the post-acute stay.

This measure is based on Medicare FFS administrative claims and uses data in the Medicare eligibility files, inpatient claims, and MDS. The eligibility files provide information such as date of birth, date of death, sex, reasons for Medicare eligibility, periods of Part A coverage, and periods in the Medicare FFS program. The data elements from the Medicare FFS claims are those basic to the operation of the Medicare payment systems and include data such as date of admission, date of discharge, diagnoses, procedures, indicators for use of dialysis services, and indicators of whether the Part A benefit was exhausted. The inpatient claims data files contain patient-level PAC and other hospital records. Historical MDS data are used to identify baseline NF residents. No data beyond those submitted in the normal course of business are required from IRF providers for the calculation of this measure.

Medicare Program Reporting.

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) Measures Information. Accessed August 3, 2023. Available from: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/irf-quality-reporting/irf-quality-reporting-program-measures-information-.

Centers for Medicare & Medicaid Services (CMS), United States. Inpatient Rehabilitation Facility Quality Reporting Program Measure Calculations and Reporting User’s Manual. Accessed August 3, 2023. Available from: www.cms.gov/files/document/irf-quality-measure-calculations-and-reporting-users-manual-v40.pdf.

Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services (CMS), United States. Measure Specifications: Medicare Spending Per Beneficiary – Post-Acute Care Skilled Nursing Facility, Inpatient Rehabilitation Facility, and Long-Term Care Hospital Resource Use Measures. Accessed August 3, 2023. Available from: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/Downloads/20160720mspbpacltchirfsnfmeasure_specs.pdf.

Inpatient Rehabilitation Facility - Quality Reporting Program: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/irf-quality-reporting/irf-quality-reporting-program-measures-information-

Technical specifications: www.cms.gov/files/document/irf-quality-measure-calculations-and-reporting-users-manual-v40.pdf

Numerator/denominator: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/Downloads/20160720mspbpacltchirfsnfmeasure_specs.pdf