Annual Calibration Updates for 2023
Implemented as of August 2023
On August 28, 2023, Premier® completed our annual CareScience® and 3M® methodology calibration updates. The updates affect all CareScience and 3M risk-adjusted outcomes (cost/charges, length of stay (LOS), readmissions, complications and mortality outcomes).
The purpose of risk adjustment is to isolate patient contributions to outcomes and determine how patient outcomes are affected by factors they bring with them to each facility encounter. Patient risk is assigned at the patient visit level and used to adjust actual (observed) outcomes of a population to control for variations in the severity of illness that each of the patients in that population brings with them at the time of hospital admission. We use the QualityAdvisor™ data to adjust the results of outcomes in patient populations to reflect how a provider performed in that population relative to what the average population with similar conditions and characteristics might expect.
Additional reasons for the calibration update include:
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Expected values reflect the most current changes in healthcare by introducing new medications and medical procedures.
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Expected values reflect the most current changes in coding practices.
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Expected values reflect the most current models and algorithms.
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Expected values account for observed national trends.
Details on the impact of the calibrations for both the CareScience and 3M methodologies are described below in two summary sections. More details around the release were shared during the Premier Academy session. Click here to view the presentation or here to play the recording.
CareScience Methodology: Impact Analysis for Calibration Updates
Patient discharges beginning with Oct. 1, 2022, will be updated to reflect the 2023 CareScience calibrations. This is to align with the Centers for Medicare & Medicaid (CMS) fiscal year and effective date of new ICD codes and coding guidelines. As with previous years, eight quarters of data, inclusive of 4Q2020-3Q2022 data, will be used to calculate the 2023 calibration updates.
A comparison of expected values between 2022 and 2023 calibrations was performed for each of the disease stratum used in the CareScience method. A DVF was calculated for each by dividing the 2022 expected value by the 2023 expected values. The DVFs allow you to adjust the expected value to look at trends from year to year without sacrificing knowledge of the constantly evolving healthcare data and practice. As a reminder, within QualityAdvisor, we have an automated solution that applies the DVFs to the appropriate timeframes. See the DVF Adjusted Outcome Analysis section below.
Below is the Impact Analysis for the 2023 calibration update.
Note: The complete list of DVFs is available upon request through your Premier data support team.
|
Outcome |
Methodology |
Expected (Previous Year) |
Expected (Current Year) |
DVF |
|---|---|---|---|---|
|
Mortality |
CareScience Analytics |
3.05% |
2.97% |
1.028 |
|
Length of Stay |
CareScience Analytics (GeoMean) |
3.23% |
3.23% |
1.002 |
|
Costs |
CareScience Analytics (GeoMean) |
$8,170 |
$8,942 |
0.914 |
|
Readmissions (HWR v4) 2021 |
CareScience Analytics |
10.2% |
9.8% |
1.038 |
|
Complications |
CareScience Analytics |
11.0% |
10.8% |
1.020 |
| ©2023 Proprietary & Confidential, Premier Inc. | ||||
For additional information please review the CSA Risk Adjustment Frequently Asked Questions (FAQ) in Chapter 3 of the Inpatient Methodologies Guide.
3M™ Methodology: Impact Analysis for Calibration Updates
The 3M methodology updates are applied to patient discharges beginning with Oct. 1, 2022, to account for the annual APR DRG update and to align with the CMS fiscal year and effective date of new ICD codes and coding guidelines. As with previous years, eight quarters of data, inclusive of 4Q2020-3Q2022 data, will be used to calculate the 2023 calibration updates.
A comparison of expected values between 2022 and 2023 calibrations was performed for each of the APR-DRGs in the 3M method. A DVF was calculated for each by dividing the 2022 expected value by the 2023 expected values. The DVFs allow you to adjust the expected value to look at trends from year to year without sacrificing knowledge of the constantly evolving healthcare data and practice.
Also, with this release, Premier has updated to APR DRG Grouper v40.0 for patient discharge records beginning 10/1/2022 and forward.
Below is the impact analysis for the 2023 calibration update.
Note: The complete list of DVFs is available upon request through your Premier data support team.
|
Outcome |
Methodology |
Expected (Previous Year) |
Expected (Current Year) |
DVF |
|---|---|---|---|---|
|
Mortality |
3M™ APR DRG |
3.37% |
3.07% |
1.100 |
|
Length of Stay |
3M™ APR DRG (ArithMean) |
4.7 |
4.8 |
0.979 |
|
Costs |
3M™ APR DRG (ArithMean) |
$13,208 |
$14,149 |
0.931 |
|
Readmissions |
3M™ APR DRG |
9.6% |
9.4% |
1.027 |
| ©2023 Proprietary & Confidential, Premier Inc. | ||||
DVF Adjusted Outcome Analysis
As a reminder, the DVF Adjusted Outcome Analysis provides an automated solution for users who would like to stabilize trended reporting across one or more calibration cycles. This analysis allows you to analyze trends from year to year while holding the benchmark at the fixed baseline.
Risk Calculator
With this release, the Risk Calculator - CareScience tool has been updated as well with the new calibrations. The Risk Calculator is an interactive tool that provides a visualization of all the risk variables contained within the CareScience Analytics model, and highlights which comorbid conditions are contributing to the risk score. Users can look at hypothetical or QualityAdvisor submitted patients to understand how comorbid conditions and demographics can impact risk scores for individual patients and can view the current and the previous calibration year values.
Outpatient Risk Adjustment
The outpatient calibration update is also completed with this release. The Outpatient model extends beyond the traditional inpatient acute care setting and allows for risk adjusted benchmarking on the following outpatient metrics:
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Same Day Surgery Returns to ED (within 1, 3, 7, 30 days)
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Observation Returns to ED (within 1, 3, 7, 30 days)
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ED Returns to ED (within 1, 3, 7, 30 days)
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ED Returns and Admitted as Acute Inpatient (within 4-7 and 30 days)