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

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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

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

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 12.29% 5.18% 57.83%
COPD 8.59% 3.69% 57.06%
Pneumonia 16.79% 6.97% 58.49%
CABG 2.30% 2.13% 7.52%
AMI 9.97% 6.04% 39.44%
Heart Failure 11.37% 4.02% 64.64%

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:

  1. 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.

  2. 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.

  3. 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.