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:
Hospitals have a challenge in tracking CMS 30-Day Mortality measures because they try to monitor more real-time information using internal hospital data, which does not have out-of-hospital information used for 30-day mortality and readmission measures. However, Dexur is an approved purchaser of Medicare claims data and, therefore, can analyze the full patient journey that impacts measures such as 30-day mortality, 30-day readmissions, MSPB, and EDAC.
To show the gap in the potential internal hospital data, Dexur analyzed in-hospital mortality at the index stay compared to the full 30-day mortality. The data shows that nearly 60% of deaths for CMS Mortality measures happen outside the index stay. The below table shows the summary stats by the measure at the national level, comparing observed rates in In-Hospital Mortality Rate at index stay vs. Total 30-day mortalities. Among all CMS conditions, heart failure has the highest percentage of deaths occurring outside the index stay with 64.64%, while CABG (Coronary Artery Bypass Grafting) has the lowest percentage at 7.52% for FY 2024 (01, Jul 2019 to 30, Jun 2022).
|CMS Mortality Measure
|In-Hospital Mortality Rate at Index Stay- Observed (%)
|30-Day Mortality Rate- Observed
|% of Total Mortalities outside of Index Stay
|All CMS Mortality Measures
How Dexur platform helps in tracking in-hospital mortality rate and out-of-hospital mortalities
Since Dexur is an approved purchaser of Medicare claims data, Dexur’s detailed Readmission and Mortality reports show the breakdown by In-Hospital Mortality vs. 30 Day readmission rate.
Hospitals have little room for error because the difference between the 10th & 90th percentile performance is small. Therefore, Dexur recommends the following actions to account for these out-of-hospital mortality measures:
Set Multiple Goals for Mortality Measures: For example, a more real-time goal for observed in-hospital mortality and a more delayed (4- 5 months delayed) goal based on the complete patient journey from a partner like Dexur and a final CMS-calibrated risk-adjusted published goal. Dexur’s goal-setting features allow for multiple goals based on different data sets for the same measure.
Implement Technology and Reporting platforms for Multi-level data + Goal tracking for a single measure. Most technology platforms have a 1-1 mapping between data source and measure. However, in complex CMS measures, data feeds (e.g., Internal Hospital Data & External 30 Day Mortality) and the associated goals would be multi-level for the same measure. Dexur’s Measures and Data feature allows for these complex multi-source data, goals, and interventions for a single measure.
Interventions should account for In-Hospital Mortality vs. Out-of-Hospital Mortality since the practices differ. For example, checking for real-time conditions in the hospital is different compared to a daily post-discharge check-in. Dexur’s interventions feature allows for seeing the impact of interventions between In-Hospital vs. Out-of-Hospital rates.