20-40% of Deaths for CMS Pneumonia, HF, AMI and COPD 30 Day Mortality Measures have an Hospice Interaction


Get Personalized Hospital Specific Presentation on Unified AI Quality, Safety, Risk & Incident Software


This article is part of the Dexur Quality Sights Newsletter, which is focused on Hospital Quality and Safety topics and is read by CEOs, CMOs, CNOs, CQOs, Quality, Safety, Compliance, Analytics & Performance teams. Please email dexurqualitysights@dexur5.com to join this newsletter and receive updates (not more than once per week).

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.

CMS Pneumonia, HF, AMI and COPD 30 Day Mortality Measures have an Hospice Interaction

Measure

30 Day Mortality - Observed Rate - Dexur Mortality Rate of TOTAL Index Patients who had a Hospice Interaction % of 30 Day Mortalities that had a Hospice Interaction
Pneumonia 16.79% 6.25% 37.20% (6.25/16.79)
Heart Failure 11.37%

4.11%

36.12% (4.11 / 11.37)

COPD

8.59%

2.68%

31.19% (2.68/8.59)

AMI

9.97%

2.27%

22.76% (2.27/9.97)

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

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.