Potentially Preventable 30-Day Post-Discharge Readmission Measure for Inpatient Rehabilitation Facility Quality Reporting Program.

The numerators of these measures are mathematically related to the number of patients/residents in the target population who have the event of a potentially preventable, unplanned readmission (PPR definitions and planned readmissions are further described below) during the specific readmission window (i.e. 30-day post-PAC discharge or within the PAC stay). Each measure includes only one readmission window. The measures do not have a simple form for the numerator and denominator—that is, the risk adjustment method does not make the observed number of readmissions the numerator, and a predicted number the denominator. Instead, the numerator is the risk-adjusted estimate of the number of unplanned readmissions that occurred within 30 days of PAC discharge. This estimate starts with the observed readmissions, and is then risk-adjusted for patient characteristics and a statistical estimate of the PAC provider's effect, beyond patient case mix.

The denominator for the PPR measures is computed the same way as the numerator, but the facility effect is set at the average. The details of the readmission types counted in the numerator and the patients who are included in the measures are below. For the eligible PAC stays at each facility, the measure denominator is the risk-adjusted expected number of readmissions. This estimate includes risk adjustment for patient characteristics with the facility effect removed. The "expected" number of readmissions is the predicted number of risk-adjusted readmissions if the same patients were treated at the average PAC provider appropriate to the measure.

Denominator Exclusions: SNF, IRF, and LTCH Post-Discharge Measures 1) Patients/residents who died during the SNF/IRF/LTCH stay. 2) Patients/residents less than 18 years old. 3) Patients/residents who were transferred at the end of a stay to another SNF/IRF/LTCH or short-term acute care hospital. 4) Patients/residents who were not continuously enrolled in Part A FFS Medicare for the 12 months prior to the SNF/IRF/LTCH admission date, and at least 30 days after SNF/IRF/LTCH discharge date. 5) Patients/residents who did not have a short-term acute-care stay within 30 days prior to a SNF/IRF/LTCH admission date. 6) Patients/residents discharged against medical advice (AMA). 7) Patients/residents for whom the prior short-term acute-care stay was for nonsurgical treatment of cancer. 8) Patients/residents who were transferred to a federal hospital from the PAC facility. 9) Patients/residents who received care from a provider located outside of the United States, Puerto Rico, or a U.S. territory. 10) SNF/IRF/LTCH stays with data that are problematic (e.g., anomalous records for hospital stays that overlap wholly or in part, or are otherwise erroneous or contradictory). This also includes SNF stays for patients who exhausted their Medicare benefits for SNF coverage. 11) SNF stays in which the prior proximal hospitalisation was for pregnancy.

Risk adjustment variables : 1) Age/sex categories 2) Original reason for Medicare entitlement (age, disability or ESRD) 3) Surgery category if present (e.g., cardiothoracic, orthopaedic), defined as in the HWR model software; the procedures are grouped using the CCS classes for ICD-9 procedures developed by AHRQ65 4) Receiving dialysis in prior short-term stay, defined by presence of revenue code 5) Principal diagnosis on prior short-term claim as in the HWR measure. The ICD-9 codes are grouped clinically using the CCS for ICD-9 diagnoses developed by AHRQ. 6) Comorbidities from secondary diagnoses on the prior short-term claim and diagnoses from earlier short-term stays up to one year before PAC admission (these are clustered using the Hierarchical Condition Categories [HCC] groups used by CMS) Prior Utilisation Measures (vary by measure): 1) Length of stay in the prior short-term hospital stay (categorical to account for nonlinearity) 2) Prior acute ICU/CCU utilisation (days) (categorical) 3) Count of prior short-term discharges in the prior year PAC-Specific Risk Adjusters 1) IRF: Aggregates of the IRF Case-Mix Groups (CMGs) for IRF patients 2) LTCH: Ventilator use — prolonged ventilation in LTCH (defined as ICD-9 procedure code on the index LTCH claim of 96.72, continuous invasive mechanical ventilation for 96 consecutive hours or more). We also intend to test multiple organ failure as a risk adjuster for the LTCH model. Risk Adjustment for Sociodemographic Status (SDS).

All measures are based on administrative claims data.

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