Comparing Readmissions Reporting in QualityAdvisor and CMS

Each analysis uses a different readmission methodology; however, all Premier readmission analyses (and their methodologies) are different from CMS in the following ways:

 

Patient Population*

Disease Categories

CMS

  • Medicare Patients who are readmitted to any facility
  • Restricted to three diseases: AMI, Heart Failure, and Pneumonia

Premier

  • All acute inpatients readmitted to the same facility (for All-Cause Hospital-Wide 30-Day Readmission based on PRA v4.0 2023 and All-Cause Hospital-Wide 30-Day Readmission based on PRA v4.0 2024)
  • All inpatient patient types readmitted to the same facility (for All-Cause 30-Day Readmission for all Inpatients)
  • Not restricted to specific diseases and more broadly based across all acute inpatients
  • Not restricted to specific diseases and more broadly based across all inpatients

*Due to the differences in data sets provided to Premier and CMS, there may be differences in the calculated Readmissions rates between Premier and CMS.

Comparing All Readmission Analyses

The following section provides a detailed side-by-side comparison of all readmission options in QualityAdvisor.

Question: Is the reason for readmission visible?

Reason for Readmission (Total Readmissions)

If a diagnosis is on the row, you can see the reason for the readmission because this analysis focuses on readmission visits. If a diagnosis is not on the row, you can drill to the patient visit detail reports to see diagnoses for the readmission visits.

Reason for Readmission (Planned vs. Unplanned)

If a diagnosis is on the row, you can see the reason for the readmission because this analysis focuses on readmission visits. If a diagnosis is not on the row, you can drill to the patient visit detail reports to see diagnoses for the readmission visits.

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

The reason for readmission is not visible on this analysis, regardless of what is on the row because the analysis focuses on index admissions. You can drill to the patient visit detail report to see diagnoses for readmission visits.

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

The reason for readmission is not visible on this analysis, regardless of what is on the row because the analysis focuses on index admissions. You can drill to the patient visit detail report to see diagnoses for readmission visits.

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

The reason for readmission is not visible on this analysis, regardless of what is on the row because the analysis focuses on index admissions. You can drill to the patient visit detail report to see diagnoses for readmission visits.

Readmission (3M™)

The reason for readmission is not visible on this analysis, regardless of what is on the row because the analysis focuses on index admissions. You can drill to the patient visit detail report to see diagnoses for readmission visits.

 

Question: Is this analysis risk-adjusted?

Reason for Readmission (Total Readmissions)

No

Reason for Readmission (Planned vs. Unplanned)

No

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Yes (CareScience Standard and Select Practice)

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Yes (CareScience Standard and Select Practice)

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

Yes (CareScience Standard and Select Practice)

Readmission (3M™)

Yes (3M™ Normatives)

 

Question: Is the analysis All-Cause?

Reason for Readmission (Total Readmissions)

Yes (by default)

Can be limited at the Numerator Selections prompt

Reason for Readmission (Planned vs. Unplanned)

Yes (by default)

Can be limited at the Numerator Selections prompt

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Yes

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Yes

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

Yes

Readmission (3M™)

Yes

 

Question: Is there a Peer version?

Reason for Readmission (Total Readmissions)

Yes

Reason for Readmission (Planned vs. Unplanned)

Yes

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Yes

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Yes

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

Yes

Readmission (3M™)

Yes

 

Question: What timeframe can be used for this reporting methodology?

Reason for Readmission (Total Readmissions)

All timeframes available in the QualityAdvisor database

Reason for Readmission (Planned vs. Unplanned)

All timeframes available in the QualityAdvisor database

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

All timeframes available in the QualityAdvisor database

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

All timeframes available in the QualityAdvisor database

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

All timeframes available in the QualityAdvisor database

Readmission (3M™)

All timeframes available in the QualityAdvisor database

 

Question: What patients are excluded?

Reason for Readmission (Total Readmissions)

Patients who:

  • Expired
  • Were transferred to another acute care facility
  • Left against medical advice

Reason for Readmission (Planned vs. Unplanned)

Patients who:

  • Expired
  • Were transferred to another acute care facility
  • Left against medical advice

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Patients who:

  • Expired
  • Were transferred to another acute care facility
  • Left against medical advice

  • Do not qualify for one of the 5 specialty cohorts that make up the Hospital-Wide Readmission cohort, including:

  • Psychiatric patients

  • Rehab patients

  • Cancer patients

  • Non-Surgical Obstetric population (neonates and mothers who do not have a procedure qualifying them for the surgical specialty cohort)

  • Have a principal diagnosis code of COVID-19 or with a secondary diagnosis code of COVID-19 coded as present on admission (POA) on the index admission claim

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Patients who:

  • Expired
  • Were transferred to another acute care facility
  • Left against medical advice

  • Do not qualify for one of the 5 specialty cohorts that make up the Hospital-Wide Readmission cohort, including:

  • Psychiatric patients

  • Rehab patients

  • Cancer patients

  • Non-Surgical Obstetric population (neonates and mothers who do not have a procedure qualifying them for the surgical specialty cohort)

  • Have a principal diagnosis code of COVID-19 or with a secondary diagnosis code of COVID-19 coded as present on admission (POA) on the index admission claim

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

Patients who:

  • Expired
  • Were transferred to another acute care facility
  • Left against medical advice

Readmission (3M™)

Patients who are:

  • Skilled Nursing Facility patients (SKN, Patient Type = 10)
  • False Labor patients with principal, admitting or secondary ICD codes of:

ICD-10

O47.00, O47.9, O47.02, O47.03, O47.1, O60.00, O60.02, O60.03

 

Question: Are same-day readmissions included?

Reason for Readmission (Total Readmissions)

Included (by default)

Can be excluded at the Readmission Details prompt

Reason for Readmission (Planned vs. Unplanned)

Included, same-day readmissions are considered planned readmissions

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Included

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Included

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

Included

Readmission (3M™)

Excluded if there are no additional visits within 30 days

 

Question: How do I see the readmission rate?

Reason for Readmission (Total Readmissions)

Readmission Rate:

  • Readmitted Cases divided by Total Denominator Cases

Reason for Readmission (Planned vs. Unplanned)

Readmission Rate:

  • Readmitted Cases divided by Total Denominator Cases

Unplanned Readmissions Rate Value:

  • Unplanned Readmitted Cases divided by Total Denominator Cases

Planned Readmissions Rate Value:

  • Planned Readmitted Cases divided by Total Denominator Cases

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Observed, which is derived from the following equation:

  • Unplanned Readmissions divided by Eligible (Outcome) Cases

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Observed, which is derived from the following equation:

  • Unplanned Readmissions divided by Eligible (Outcome) Cases

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

Observed, which is derived from the following equation:

  • Outcome Cases with Readmissions divided by Eligible (Outcome) Cases

Readmission (3M™)

Readmission Rate:

  • Readmitted Cases divided by Cases

 

Question: How are readmitted cases stratified?

Reason for Readmission (Total Readmissions)

By diagnoses or other selected characteristics

Reason for Readmission (Planned vs. Unplanned)

By diagnoses or other selected characteristics

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

By diagnoses or other selected characteristics

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

By diagnoses or other selected characteristics

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

By diagnoses or other selected characteristics

Readmission (3M™)

By diagnoses or other selected characteristics

 

Question: What Patient Types are included?

Reason for Readmission (Total Readmissions)

All Patient Types (by default) User-defined at the Readmission Details and Patient Type Prompts

Reason for Readmission (Planned vs. Unplanned)

Inpatient Type only (08)

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Inpatient Type only (08)

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Inpatient Type only (08)

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

All Inpatient Types (by default)

Readmission (3M™)

All Patient Types except Skilled Nursing Patients (SKN, Patient Type = 10)

 

Question: Does this analysis exclude planned readmissions?

Reason for Readmission (Total Readmissions)

No

Reason for Readmission (Planned vs. Unplanned)

No

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Yes

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Yes

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

No

Readmission (3M™)

No

 

Question: What version of the Planned Readmission Algorithm is utilized?

Reason for Readmission (Total Readmissions)

N/A

Reason for Readmission (Planned vs. Unplanned)

Either Planned Readmission Algorithm v4.0 2023 or Planned Readmission Algorithm v4.0 2024 can be selected for this analysis

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Planned Readmission Algorithm v4.0 2023

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Planned Readmission Algorithm v4.0 2024

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

N/A

Readmission (3M™)

N/A

 

Question: What is the interval between the index visit and the readmission visit?

Reason for Readmission (Total Readmissions)

User defined at the Readmission Days prompt

Reason for Readmission (Planned vs. Unplanned)

User defined at the Readmission Days prompt

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Within 30 Days

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Within 30 Days

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

Within 30 Days

Readmission (3M™)

Within 30 Days

 

Question: Which visit has the readmission flag?

Reason for Readmission (Total Readmissions)

Readmitted Visit

Reason for Readmission (Planned vs. Unplanned)

Readmitted Visit

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

Index Visit

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

Index Visit

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

Index Visit

Readmission (3M™)

Index Visit

 

Question: What returns for the attribute on the row?

Reason for Readmission (Total Readmissions)

The readmission visit that had the attribute

Reason for Readmission (Planned vs. Unplanned)

The readmission visit that had the attribute

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

The index visit that had the attribute

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

The index visit that had the attribute

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

The index visit that had the attribute

Readmission (3M™)

The index visit that had the attribute

 

Question: What does "show items" show?

Reason for Readmission (Total Readmissions)

All cases and readmitted cases for the selected attribute

Reason for Readmission (Planned vs. Unplanned)

All cases and readmitted cases for the selected attribute

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

All cases for the selected attribute

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

All cases for the selected attribute

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

All cases for the selected attribute

Readmission (3M™)

All cases for the selected attribute

 

Question: What admissions are eligible?

Reason for Readmission (Total Readmissions)

For each index admission, only the first subsequent admission is considered when defining a readmission visit

Reason for Readmission (Planned vs. Unplanned)

For each index admission, only the first subsequent Acute Inpatient admission is considered when defining a readmission visit

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2022 (CareScience)

For each index admission, only the first subsequent Acute Inpatient unplanned admission is considered when defining a readmission visit

Note: COVID-19 index admissions are removed from the specialty cohorts

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)

For each index admission, only the first subsequent Acute Inpatient unplanned admission is considered when defining a readmission visit

Note: COVID-19 index admissions are removed from the specialty cohorts

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)

For each index admission, only the first subsequent Acute Inpatient unplanned admission is considered when defining a readmission visit

Note: COVID-19 index admissions are removed from the specialty cohorts

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)

For each index admission, only the first subsequent Inpatient admission is considered when defining a readmission visit

Readmission (3M™)

For each index admission, only the first subsequent admission is considered when defining a readmission visit

 

Question: Which detail analyses are available?

Reason for Readmission (Total Readmissions)
  • Facility Readmission Patient Detail Analysis
  • Facility Readmission Patient Visit Detail Analysis

Reason for Readmission (Planned vs. Unplanned)
  • Facility Readmission Patient Detail Analysis
  • Facility Readmission Patient Visit Detail Analysis

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2023 (CareScience)
  • Facility Risk-Adjusted Readmission Patient Detail Analysis
  • Facility Risk-Adjusted Readmission Patient Visit Detail Analysis
  • Facility All Patient Detail Analysis

Risk-Adjusted All-Cause Hospital-Wide 30-Day Readmission PRA v4.0 2024 (CareScience)
  • Facility Risk-Adjusted Readmission Patient Detail Analysis
  • Facility Risk-Adjusted Readmission Patient Visit Detail Analysis
  • Facility All Patient Detail Analysis

Risk-Adjusted All-Cause 30-Day Readmission - All Inpatients (CareScience)
  • Facility Risk-Adjusted Readmission Patient Detail Analysis
  • Facility Risk-Adjusted Readmission Patient Visit Detail Analysis
  • Facility All Patient Detail Analysis

Readmission (3M™)
  • Facility All Patient Detail Analysis