The Standardized Ratio of Emergency Department Encounters Occurring Within 30 Days of Hospital Discharge for Dialysis Facilities (ED30) is defined to be the ratio of observed over expected events. The numerator is the observed number of index discharges from acute care hospitals that are followed by an outpatient emergency department encounter within 4-30 days after discharge for eligible adult Medicare dialysis patients treated at a particular dialysis facility. The denominator is the expected number of index discharges followed by an ED encounter within 4-30 days given the discharging hospital’s characteristics, characteristics of the dialysis facility’s patients, and the national norm for dialysis facilities. Note that in this document, acute care hospital includes critical access hospitals and “emergency department encounter” always refers to an outpatient encounter that does not end in a hospital admission. This measure is calculated as a ratio but can also be expressed as a rate.
When used for public reporting, the measure calculation will be restricted to facilities with at least 11 eligible index discharges in the reporting year. This restriction is required to ensure patients cannot be identified due to small cell size.
The observed number of index hospital discharges during a year that are followed by an emergency department encounter within 4–30 days of the discharge among eligible adult Medicare patients at a facility.
Denominator
1.15 Denominator
The expected number of index hospital discharges for eligible adult Medicare ESRD dialysis patients during the two year period that are followed by an emergency department encounter within 4-30 days of the discharge among eligible patients at a facility. The expected value is the result of a risk-adjusted predictive model adjusted for the characteristics of the patients, the dialysis facility, and the discharging hospitals.
Exclusions
Exclusions
Index Discharge exclusions that are implicit in the denominator definition include discharges for which the patient: • Has Medicare Advantage coverage at the time of the index discharge • Has had ESRD for 90 days or less at time of discharge • Is less than 18 years of age at the time of discharge
We also exclude discharges and emergency department encounters for which the patient was: • Actively enrolled in hospice at any time of during the calendar month of the discharge date or ED encounter admit date
Outpatient Medicare claims are the source of ED encounter data, and since outpatient claims are not available for Medicare Advantage (MA) patients, we cannot identify ED encounters for MA patients. Therefore, we exclude index discharges for patients with MA at the time of discharge.
The hospice exclusion is needed because hospice patients are considered to be under the purview of hospice care givers and may have other reasons for Emergency Department use such as pain management.
Additionally we exclude hospital discharges that: • Do not result in a live discharge • Are against medical advice • Include a primary diagnosis for cancer, mental health or rehabilitation (see below for excluded CCSs) • Are from a PPS-exempt cancer hospital • Are followed within three days of discharge by the patient being transplanted, discontinuing dialysis, recovering renal function, being lost to follow-up, having another hospitalization, or having an emergency department visit
Measure Record
Most Recent Endorsement Activity
Endorsed All-Cause Admissions and Readmissions Spring Cycle 2020
Public Comments