Facility-level risk-standardised rate of acute, unplanned hospital visits within 7 days of a colonoscopy procedure performed at a Rural Emergency Hospital among Medicare Fee-For-Service (FFS) patients aged 65 years and older. An unplanned hospital visit is defined as an emergency department (ED) visit, observation stay, or unplanned inpatient admission.

The outcome for this measure is all-cause, unplanned hospital visits within 7 days of an outpatient colonoscopy performed at a Rural Emergency Hospital. We define a hospital visit as any emergency department (ED) visit, observation stay, or unplanned inpatient admission.

Outpatient colonoscopies performed at Rural Emergency Hospitals for Medicare FFS patients aged 65 years and older. Specifically: The measure includes patients undergoing routine (not high-risk) colonoscopies, identified using Healthcare Common Procedure Coding System (HCPCS) codes and Current Procedural Terminology (CPT) codes. Qualifying colonoscopy procedures are not included in the measure if they are concurrently billed with a high-risk colonoscopy procedure code. The measure includes patients with continuous enrolment in Medicare FFS Parts A and B in the 12 months prior to the procedure.

Denominator Exclusions: 1) Colonoscopies for patients who lack continuous enrolment in Medicare FFS Parts A and B in the 1 month after the procedure. 2) Colonoscopies that occur concurrently with high-risk upper gastrointestinal (GI) endoscopy procedures. 3) Colonoscopies for patients with a history of inflammatory bowel disease (IBD) or diagnosis of IBD at time of index colonoscopy or on a subsequent hospital visit outcome claim. 4) Colonoscopies for patients with a history of diverticulitis or diagnosis of diverticulitis at time of index colonoscopy or on a subsequent hospital visit outcome claim. 5) Colonoscopies followed by a subsequent outpatient colonoscopy procedure within 7 days. 6) Colonoscopies that occur on the same day and at the same hospital as an ED visit that is billed on a different claim than the index colonoscopy, unless the ED visit has a diagnosis indicative of a complication of care. 7) Colonoscopies that are billed on the same hospital claim as an ED visit and that occur on the same calendar day, unless the ED visit has a diagnosis indicative of a complication of care. 8) Colonoscopies that are billed on the same hospital outpatient claim and that occur after the ED visit. 9) Colonoscopies that are billed on the same hospital outpatient claim as an observation stay.

Risk Adjustment Model Variables: Congestive Heart Failure, Ischaemic Heart Disease, Arrhythmias, Stroke/Transient Ischaemic Attack (TIA), Chronic Lung Disease, Metastatic Cancer, Liver Disease, Iron Deficiency Anaemia, Disorders of Fluid/Electrolyte/Acid-Base, Pneumonia, Psychiatric Disorders, Drug and Alcohol Abuse/ Dependence.

Facility, Hospital, Agency.

Administrative Data (non-claims) Claims Data.

Not applicable.

Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy. Last updated 28.12.2023. Accessed 8.04.2024 cmit.cms.gov/cmit/#/MeasureView?variantId=12916&sectionNumber=1

Targets population 65+ cmit.cms.gov/cmit/#/MeasureView?variantId=12916&sectionNumber=8 Risk adjustments models: www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/downloads/colonoscopyupdatereportmay2016oqr.pdf