This article is part of a series that highlights challenges that hospitals face by not having access to out-of-hospital data and the patient journey. See prior articles in the series here.

Nearly 30% of Readmissions are to a Different Hospital From the Index Stay

Nearly 60% of Deaths for CMS Mortality Measures Happen Outside the Index Stay

CMS Mortality measures are a critical part of CMS Star Ratings (~22% of overall weightage) and VBP (~25% of Weightage). Within the CMS Mortality measures, Pneumonia, HF, AMI and COPD are the most common measures in Mortality. A big gap while Hospitals try to measure 30 Day mortality is that Hospitals are blind to what happens outside their walls and nearly 60% of deaths are outside the Index Stay. Since, Dexur is an approved purchaser of Medicare Claims data, we can provide insights into what happens out of the Index stay and how what percentage of patient deaths can be potentially impacted.

As part of the “Out of Hospital Data Analysis” series, Dexur analyzed hospice interacted deaths. A key point about Hospice deaths is that the 30-day mortality measures used by CMS exclude patients who were enrolled in the Medicare hospice program within 12 months of their index admission or on the first day of their admission. Patients who are designated for hospice care within the first 24 hours of their hospital stay and die within 30 days of discharge are not counted against the hospital's score. However, if a patient goes to the Hospice after the first 24 hours of their hospital stay, the mortalities will be included in the Hospital’s score.

Dexur’s analysis of national level medicare claims data (see below table) shows that the percentage of patients who died within 30 days of Admission and had a Hospice interaction was 37% for Pneumonia patients, 36% for Heart Failure patients, 31% for COPD patients and 22% for AMI patients.

Dexur can provide similar statistics at each individual hospital and measure level. This will help hospitals in the following ways:

• Benchmarking and Best Practices: By having access to such detailed data, hospitals can benchmark their performance against peers and adopt best practices to ensure they are providing the best possible care to their patients.

• Informed Decision Making: Having insights into patients who interacted with hospice can enable hospitals to make data-driven decisions regarding patient care after discharge. This is critical for patients who are potentially at risk and might benefit from hospice care.

• Patient and Family Counseling: Understanding the rate of hospice interactions can guide hospitals on when and how to introduce the idea of hospice care to patients and their families, ensuring they are well-informed and comfortable with their choices.

• Risk Stratification: By analyzing out-of-hospital data, hospitals can better stratify patients based on their risk levels. Those with higher chances of mortality and potential hospice interaction can be managed differently than lower-risk patients.

• Enhanced Care Coordination: With insights into the post-discharge journey of the patient, hospitals can foster a better relationship and coordination with local hospice providers, ensuring seamless patient care.

• Performance Improvement: Understanding the numbers allows hospitals to identify gaps in their current care process, leading to enhanced quality improvement initiatives.

• Financial and Operational Impact: By accurately understanding and planning for post-discharge care, hospitals can optimize resources, potentially leading to better operational efficiency and financial outcomes.

• Tailored Patient Education: By recognizing the percentage of patients who might require hospice care, hospitals can create tailored educational content for these patients, ensuring they know what to expect and how to get the best possible care.

• Community Relations: Demonstrating a commitment to understanding and acting upon patient care post-discharge can enhance a hospital's reputation in the community, emphasizing that patient well-being is a priority, both inside and outside the hospital walls.

By giving hospitals a clearer picture of what happens post-discharge, especially concerning hospice care, Dexur empowers them to take proactive measures, ensuring better patient outcomes, higher satisfaction rates, and potentially improved CMSStar Ratings, Readmissions & Mortality, VBP & MSPB and other quality programs.