This measure is a re-specified version of the hospital-level measure, “Hospital-Wide All-Cause, Unplanned Readmission Measure” (NQF #1789), which was developed for patients who are 65 years or older, are enrolled in Fee-for-Service (FFS) Medicare and are hospitalized in non-federal hospitals.
This re-specified measure attributes hospital-wide index admissions to up to three participating MIPS Eligible Clinician Groups (“providers”), rather than to hospitals. It assesses each provider’s rate of 30-day readmission, which is defined as unplanned, all-cause readmission within 30 days of hospital discharge for any eligible condition.
The measure reports a single summary risk adjusted readmission rate (RARR), derived from the volume-weighted results of five different models, one for each of the following specialty cohorts based on groups of discharge condition categories or procedure categories: surgery/gynecology; general medicine; cardiorespiratory; cardiovascular; and neurology, each of which will be described in greater detail below.
- Measure TypeElectronic Clinical Quality Measure (eCQM)Level Of AnalysisMAT output not attachedAttachedNumerator
The outcome for this measure is readmission within 30-days of a hospital discharge. We define readmission as an inpatient admission for any cause, except for certain planned readmissions, within 30 days from the date of discharge from an eligible index admission.
Additional details are provided in S.5 Numerator DetailsDenominatorThe measure includes admissions for Medicare beneficiaries who are 65 years and older and are discharged from any non-federal, acute care inpatient U.S. hospitals (including territories) with Medicare Part A enrollment for the 12 months prior to admission and Part A enrollment for the 30 days after discharge. These are called ‘index admissions’.
Outcome attribution:
There are three eligible clinician groups for attribution: 1) the Primary Inpatient Care Provider, 2) the Discharge Clinician and 3) the Outpatient Primary Care Physician.
1) Primary Inpatient Care Provider: All patient-facing claims for the patient filed during the stay are identified and totaled by clinicians identified on each claim; the admission is attributed to the clinician with the greatest charges billed. The cost of charges billed (as opposed to number of charges) better reflects the appropriate clinician, especially for the surgical specialty cohort. The identified primary inpatient care provider may also be the discharge clinician.
2) Discharge Clinician: Identified by Current Procedural Terminology [CPT®] code 99238 or 99239 within the last three days of admission OR CPTs 99231, 99232, 99233 billed on the last day of admission. If none of these codes found, a Discharge Clinician is not assigned.
3) Outpatient Primary Care Physician: The clinician who provides the greatest number of claims for primary care services during the 12 months prior to the hospital admission date.
Eligible clinician groups are defined by grouping eligible clinicians who use the same Taxpayer Identification Number (TIN). Index admissions are attributed to a clinician group by each of these rules. Though an admission may be attributed to three distinct eligible clinician groups, it will often be the case that two or even all three of the above listed roles for a given patient are filled by clinicians assigned to the same clinician group. In the case of multiple assignments of an admission to the same eligible clinician group, each admission is included only once when measuring the eligible clinician group.
Importantly, this implies that while there are three different rules for attribution, these are not distinguished when measuring clinician group performance. While a clinician group can have admissions attributed to them in multiple capacities – for instance, a clinician from the same group may be both a Discharge Clinician for some patients and a Primary Inpatient Care Provider for others – all attributed admissions are used to construct a single score for that eligible clinician group. Thus, while we report some results by attribution role, we report measure scores only for “unique eligible clinician groups”.
Additional details are provided in S.7 Denominator Details.ExclusionsFrom the cohort, we exclude admissions if:
1. The patient is discharged against medical advice (AMA)
2. The patient is discharged from a PPS-exempt cancer hospital
3. The patient is admitted primarily for the medical treatment of cancer
4. The patient is admitted primarily for the treatment of psychiatric disease
5. The patient is admitted primarily for “rehabilitation care; fitting of prostheses and adjustment devices” (CCS 254)
6. Admissions without 30 Days of Post-Discharge Enrollment are excluded
7. Admissions cannot be identified in IDR database
8. The admission cannot be attributed to an eligible clinician.
Further exclusion details can be found in S.9 Denominator Exclusion DetailsAll information required to stratify the measure resultsOffAll information required to stratify the measure resultsOffTesting Data Sources
- Measure StructureNational Quality Strategy PrioritiesPatient SafetyReadmissions
- Risk AdjustmentRisk adjustment approachOffRisk adjustment approachOffConceptual model for risk adjustmentOffConceptual model for risk adjustmentOff
- Current or planned use(s)Current Use(s)Planned Use
- Most Recent Endorsement ActivityEndorsed All-Cause Admissions and Readmissions Fall Cycle 2019Initial EndorsementNext Planned Maintenance ReviewSpring 2024Endorsement StatusLast Updated
- Do you have a secondary measure developer point of contact?OffThe measure developer is NOT the same as measure stewardOffSteward Organization EmailSteward Organization Copyright
N/A
- Detailed Measure SpecificationsNoLogic ModelOffImpact and GapNoFeasibility assessment methodology and resultsNoAddress health equityNoMeasure’s use or intended useNo508 ComplianceOffIf no, attest that all information will be provided in other fields in the submission.Off