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

Identifying Attributes

Care Settings
Rural and Remote Care
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Rural Emergency Hospital Quality Reporting Program
Type of Quality Indicator
Outcome
IOM Quality Dimension
Safety
Domain
Hospital Readmission

Defining Attributes

Definition

Facility-level risk-standardised rate of acute, unplanned hospital visits within 7 days of an outpatient surgical 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.

Numerator

The outcome is all-cause, unplanned hospital visits, defined as 1) an inpatient admission directly after the surgery or 2) an unplanned hospital visit post discharge (emergency department [ED] visit, observation stay, or unplanned inpatient admission) occurring after discharge and within 7 days of the outpatient surgical procedure performed at a Rural Emergency Hospital. If more than one unplanned hospital visit occurs, only the first hospital visit within the outcome time-frame is counted in the outcome.

Denominator

Outpatient same-day surgeries performed at Rural Emergency Hospital for Medicare FFS patients aged 65 years and older.

Exclusions

Denominator Exclusions: 1. Surgeries performed at Rural Emergency Hospitals, for patients without continuous enrolment in Medicare FFS Parts A and B in the 7 days after the surgery. 2. Surgeries performed at Rural Emergency Hospitals, for patients who have an ED visit on the same day but billed on a separate claim unless the ED visit has a diagnosis indicative of a complication of care. 3. Surgeries performed at Rural Emergency Hospitals, that are billed on the same hospital claim as an emergency department (ED) visit and that occur on the same calendar day unless the ED visit has a diagnosis indicative of a complication of care. 4. Surgeries performed at Rural Emergency Hospitals, that are billed on the same hospital outpatient claim and that occur after the ED visit. 5. Surgeries performed at Rural Emergency Hospitals, that are billed on the same outpatient claim as an observation stay.

Use of Risk Adjustment
Yes
Risk Adjustments

Age minus 65 (years above 65) Cancer (CC 8-14) Diabetes and DM Complications (CC 17-19, 122, 123) Disorders of Fluid/Electrolyte/Acid-Base (CC 24) Intestinal Obstruction/Perforation (CC 33) Inflammatory Bowel Disease (CC 35) Bone/Joint/Muscle Infections/Necrosis (CC 39) Haematological Disorders Including Coagulation Defects and Iron Deficiency (CC 46, 48, 49) Dementia or Senility (CC 51-53) Psychiatric Disorders (CC 57-63) Hemiplegia, Paraplegia, Paralysis, Functional Disability (CC 70, 71, 73, 74, 103-105, 189, 190) Other Significant CNS Disease (CC 77-80) Cardiorespiratory Arrest, Failure and Respiratory Dependence (CC 82-84) Congestive Heart Failure (CC 85) Ischaemic Heart Disease (CC 86-89) Hypertension and Hypertensive Disorders (CC 94, 95) Arrhythmias (CC 96, 97) Vascular Disease (CC 106-109) Chronic Lung Disease (CC 111-113) UTI and Other Urinary Tract Disorders (CC 144, 145) Pelvic Inflammatory Disease and Other Specified Female Genital Disorders (CC 147) Chronic Ulcers (CC 157-161) Cellulitis, Local Skin Infection (CC 164) Prior Significant Fracture (CC 169-171) Morbid Obesity (CC 22) Work Relative Value Units Surgical Body System: Miscellaneous diagnostic and therapeutic procedures Cardiovascular Digestive Ear Endocrine Female Genitalia Hemic-Lymphatic Skin & Breast Male Genitalia Musculoskeletal Nervous Nose-Throat-Pharynx Respiratory Urinary.

Stratifications

Stratified by dual eligibility by The Within-Facility Disparity Method and The Across-Facility Disparity Method, reported confidentially to hospitals.

Data Attributes

Type of Data Collection
Administrative data
Data Collection Methods

Claims Data Administrative Data.

Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods

Unclear but part of Cost and Efficiency Fall 2023.

Reporting Frequency
Reporting Frequency in Days
Indicator Has Recommended Targets
No

Source and Reference Attributes

Evidence Source

Risk-standardized hospital visits within 7 days after hospital outpatient surgery. Last updated 28.12.2023. Accessed 8.04.2024. cmit.cms.gov/cmit/#/MeasureView?variantId=12917&sectionNumber=1

Technical Specifications
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