August 28, 2023 Release Notes

With this release we have added the 2022 version (Version 11.0) of the CMS Hospital-Wide Readmission methodology and Planned Readmission Algorithm to QualityAdvisor's risk-adjusted reporting. The newly added methodology is called the CMS All-Cause Hospital-Wide (HWR) 30-Day Readmission based on Planned Readmission Algorithm (PRA) v4.0 2022. This methodology applies to patient discharges beginning October 1, 2018 and forward.

QualityAdvisor maintains two versions of CMS Readmission methodologies to allow you to choose when to move to the latest methodology. The current versions now include:

• CMS All-Cause Hospital-Wide 30-Day Readmission (HWR) Methodology Based on PRA v4.0 2022 (discharges October 1, 2018 and forward)

• CMS All-Cause Hospital-Wide 30-Day Readmission (HWR) Methodology Based on PRA v4.0 2021 (discharges October 1, 2018 and forward)

Note: The CMS All-Cause Hospital-Wide 30-Day Readmission (HWR) Methodology Based on PRA v4.0 2020 is removed with this release.

COVID Exclusion

Per last year's Release Notes, Premier did not exclude COVID patients from the CMS All-Cause Hospital-Wide 30-Day Readmission (HWR) Methodology Based on PRA v4.0 2021.

However, COVID-19 patients are excluded from the new CMS All-Cause Hospital-Wide 30-Day Readmission (HWR) Methodology Based on PRA v4.0 2022 implemented with this release.

Summary Overview

The 2022 version of the Hospital-Wide Readmission methodology (HWR PRA v4.0 2022) varies from previous versions due to the change to remove COVID cases from the HWR cohort and readmission cases.

Click Here to Expand this Section for Detailed Information: The following updates have been made to the HWR measure for Version 11.0 with the intent to maintain the clinical integrity of the algorithm and cohort definitions: The removal of COVID-19 patients from all five specialty cohorts Potentially planned procedures: The addition of ICD-10-PCS codes (associated with AHRQ CCS procedure categories 49 and 146) to the singular ICD-10-PCS code list. The singular ICD-10-PCS code list previously had ICD-10-PCS codes associated with both of these AHRQ CCS procedure categories Acute diagnoses The removal of one ICD-10-CM code (associated with AHRQ CCS diagnosis category 97) from the singular ICD-10-CM code list; and The addition of ICD-10-CM codes (associated with AHRQ CCS diagnosis categories 115, 167, 225, 237, 238, 239, 242, 244, 661, and 662) to the singular ICD-10-CM code list. The singular ICD-10-CM code list previously had ICD-10-CM codes associated with all of these AHRQ CCS diagnosis categories COVID-19 readmissions (ICD-10-CM U07.1) are not eligible for the readmission outcome and are excluded

Notes

• A new prompt option for the HWR PRA v4.0 2022 methodology has been added to all relevant analyses

• All relevant analyses have been updated to include Readmission metrics based on the new HWR PRA v4.0 2022 methodology

Additional information is available in the Inpatient Methodologies Guide Chapter 7 - Readmissions >All-Cause Hospital-Wide 30-Day Readmission Methodology based on PRA v4.0 2022.

Updated population tables are available in PRA Version 4.0 2022 - Overview and Population Tables.

 

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We have completed our annual calibration updates, which affect all of the CareScience and 3M™ Risk-Adjusted Outcomes: Cost, Charges, Length of Stay [LOS], Readmissions, Complications, and Mortality.

With the 2023 Calibration update, data is rescored for patient discharges from 10/1/2022 and forward for both CSA Inpatient and Outpatient Outcomes.

We have also updated to the APR DRG Grouper v40.0 for patient discharges beginning 10/1/2022 and forward.

• Eight quarters of data, inclusive of 4Q2020-3Q2022 data, is used to calculate the 2023 calibration updates for both Inpatients and Outpatients

• The 2023 scaling factors are applied to all CareScience outcomes for patient discharges beginning 10/1/2022 and forward, except for the Charge outcome (only Standard Practice expected values calculated for this outcome) and new HWR PRA v4.0 2022 outcome

• The 2023 CSA Outpatient calibrations data is rescored from 10/1/2022 and forward for the following outcomes:

Same Day Surgery Returns to ED (within 1, 3, 7, 30 days) – 4 outcomes

Observation Returns to ED (within 1, 3, 7, 30 days) – 4 outcomes

ED Returns to ED (within 1, 3, 7, 30 days) – 4 outcomes

ED Returns and Admitted as Acute Inpatient (within 4-7 and 30 days) – 2 outcomes

Notes

• Please review the Annual Calibration Updates for 2023 for detailed information

• A new Frequently Asked Questions document all about CSA Risk Adjustment Methodology is now available in Chapter 3 of the Inpatient Methodologies Guide

• As a reminder, if a patient qualifies as an outcome case for length of stay, charges, or cost, there is logic used in the CareScience model to determine if the patient's calculated risk falls within the allowable range (trim point values or CSA outlier logic). Every year the minimum and maximum values are updated with new ranges to account for changes in care practice

• The Data Vintage Factor Adjusted Outcome Analysis Facility and Peer reports are updated to account for both the annual 2023 calibration updates, and the CareScience Analytics model enhancements

• Select Practice is not currently available for CSA OP risk-adjustment and will not be added with this year’s calibration release

2023 CareScience Analytics Model Enhancements

• Race Dropped as a Risk Factor with 2023 CareScience Risk-Adjustment Model Update (for both Inpatients and Outpatients)

Premier and Premier’s Measurement Advisory Board have determined that from the 2023 calibration and moving forward, we will no longer include race in our risk adjustment to avoid potential inequity in measurement (effective for patient discharges beginning 10/1/2022 and forward). There is minimal effect to the risk models as comorbid conditions commonly present in marginalized communities will capture a significant portion of the additional risk race added to the model.

• Reinstated — Neonatal withdrawal symptoms from maternal use of drugs of addiction (P96.1) as a standalone condition for newborns (effective for discharges 10/1/2022 and forward)

In the 2022 model, the code is grouped in a CCSR category, which dilutes the effect of this code.

 

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Premier has refreshed the outlier minimum and maximum values using calendar year 2021 data. Prior to this release, the boundary values were based on calendar year 2020 data.

The impact to the number of outliers in the database is minimal, shifting from 11.7267% of inpatients currently as outliers to 11.7266% of inpatients as outliers as a result of the change.

Refer to the Outlier Prompt Methodology for more information.

Notes

• The Outlier updates will also be available in CPM Hospital and Quality Console once the profile definitions and dashboards have been reprocessed with a data release.

 

The Facility Profiling Analysis now reflects metrics based on data from CMS FY2022 (October 1, 2021 to September 30, 2022).

 

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. All CSA 2023 Model Year changes are incorporated into each version of the DVF Adjusted Outcome Analyses (Facility & Peer, CareScience & 3M).

Notes

• The new HWR PRA v4.0 2022 Readmission methodology will not be added to the report this year, since there is no DVF needed, and that outcome is available within other reporting options

• The HWR PRA v4.0 2021 Readmission methodology is added to the report this year

• The HWR PRA v4.0 2020 Readmission methodology is retired

 

The Disease Strata by Outcome analysis was introduced to QualityAdvisor in October 2022, following the CSA 2022 move to CCSR disease strata. With this August 2023 release, the analysis is updated with the new CSA 2023 calibrations.

Notes

• The CSA 2023 version replaces the CSA 2022 version for this analysis

• Readmissions metrics now include both HWR Methodology Based on PRA v4.0 2022 and PRA v4 2021

• Readmission metrics based on HWR PRA v4 2020 are removed

 

With this release, we updated the Risk Calculator to factor in all relevant aspects of this August 2023 release, including:

• All CSA 2023 Risk Model year updates

• All calibration updates

• The addition of the new All-Cause HWR PRA v.4.0 2022 Readmission methodology

Notes

• A new tab has been added for the new All-Cause HWR PRA v.4.0 2022 Readmission methodology

• HWR PRA v4.0 2020 Readmission methodology has been retired from the Risk Calculator

• With the addition of the new CSA 2023 model year, the oldest model year (CSA 2020) has been rolled off of the calculator

 

With this release, Premier has completed the annual archiving of data from the QualityAdvisor database. However, for the 2023 Calibration, Premier has decided to alter the schedule from what was previously implemented in June 2021, which was to align with the CMS fiscal year.

For this year, since PSI-90 for CMS HACRP v12 or v13 have not been made available for implementation in time for our annual archiving, we must continue to maintain v11 in QualityAdvisor. Given that the performance period of v11 overlaps our standard archiving schedule, we have decided to only archive through June 30, 2018 in order to keep v11 available for members to use.

We will re-evaluate our archive schedule with next year's calibration release and aim to align back with CMS at that time.

 

You will see additional PINC AI cosmetic updates implemented in QualityAdvisor with this August release. Specifically we have updated several report templates using the new branding. However, the new template is only applied to reports generated starting August 28, 2023 and going forward. Reports generated prior to this release are unchanged, and continue to display using the previous template.

Note: Screen shots used as illustrations in the Help documentation will be updated over time.