The measure estimates a hospital-level risk-standardized readmission rate (RSRR) for patients discharged from the hospital with a principal diagnosis of heart failure (HF). Readmission is defined as unplanned readmission for any cause within 30 days of the discharge date for the index admission. Readmissions are classified as planned and unplanned by applying the planned readmission algorithm. The target population is patients age 65 and over. The Centers for Medicare & Medicaid Services (CMS) annually reports the measure for patients who are 65 years or older and are enrolled in fee-for-service (FFS) Medicare and hospitalized in non-federal hospitals or are patients hospitalized in Veterans Health Administration (VA) facilities.
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1.5 Measure Type1.7 Electronic Clinical Quality Measure (eCQM)1.8 Level Of Analysis1.9 Care Setting1.20 Testing Data Sources
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1.14 Numerator
The outcome for this measure is 30-day readmissions. We define readmissions as any inpatient acute care admission, with the exception of certain planned readmissions, within 30 days from the date of discharge from an index admission with a principal discharge diagnosis of HF in patients 65and older. If a patient has more than one unplanned admission (for any reason) within 30 days after discharge from the index admission, only one is counted as a readmission. The measure looks for a dichotomous yes or no outcome of whether each admitted patient has an unplanned readmission within 30 days. However, if the first readmission after discharge is considered planned, any subsequent unplanned readmission is not counted as an outcome for that index admission, because the unplanned readmission could be related to care provided during the intervening planned readmission rather than during the index admission.
Additional details are provided in S.5 Numerator Details.
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1.15 Denominator
The cohort includes admissions for patients aged 65years and older discharged from the hospital with a principal discharge diagnosis of HF, and with a complete claims history for the 12 months prior to admission. The measure is publicly reported by CMS for those patients 65 years and older who are Medicare FFS or VA beneficiaries admitted to non-federal or VA hospitals, respectively.
Additional details are provided in S.7 Denominator Details
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Exclusions
The 30-day HF readmission measure excludes index admissions for patients:
1. Without at least 30 days of post-discharge enrollment in Medicare FFS (in the case of patients who are not VA beneficiaries);
2. Discharged against medical advice (AMA);
3. Admitted within 30 days of a prior index admission for HF; and
4. With a procedure code for LVAD implantation or heart transplantation either during the index admission or in the 12 months prior to the index admission.
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Most Recent Endorsement ActivityEndorsed All-Cause Admissions and Readmissions Fall Cycle 2020Initial EndorsementLast Updated
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StewardCenters for Medicare & Medicaid ServicesSteward Organization POC EmailSteward Organization Copyright
N/A
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Risk Adjustment
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6.1.2 Current or Planned Use(s)6.1.3 Current Use(s)
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Use In Federal Program
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