In the pursuit of improving healthcare quality and patient outcomes, the Centers for Medicare & Medicaid Services (CMS) rely on various measures to evaluate the performance of hospitals and healthcare providers. Two crucial indicators that have garnered significant attention to assess hospital performance are readmission and mortality rates. These measures are crucial in measuring Hospitals’ performance in various CMS quality programs. For instance, readmissions and mortality measures constitute 44% weightage in the calculation of CMS Star Ratings, and readmissions are the sole driver of the Hospital Readmissions Reduction Program (HRRP). However, focusing on the readmission and mortality measures are rife with opportunity and also fraught with risk because Dexur’s analysis shows that the difference between the bottom 10th percentile and the top 90th percentile hospital is only 1-5% for most measures. This article explain the nuances of the percentiles and what it means for hospitals.

Understanding the 10th and 90th Percentile Measures

The percentiles refer to the statistical points that divide a dataset into ten equal groups, each representing 10% of the data. In the context of CMS readmission and mortality measures, these percentiles reflect the performance range of hospitals in these particular measures. The 10th percentile represents hospitals with the highest readmission or mortality rates, while the 90th percentile includes hospitals with the lowest rates. Interestingly, the difference between the 10th and 90th percentiles of CMS readmission and mortality measures is often observed to be surprisingly narrow. The table below shows the different percentile rates of few 30-day readmission and mortality measures for 2023:

Dexur’s analysis shows that the difference between the 10th and 90th percentiles of most readmission and mortality measures is between 1-5 percent. In other words, the performance range between the highest and lowest-performing hospitals is often much tighter than expected. This narrow gap challenges healthcare providers to identify areas of weaknesses and put more effort in moving to a higher performance percentile.

What does this narrow gap between the 10th & 90th percentiles mean for Hospitals Quality Program Scores?

Dexur AI Simulations Can Help You Understand which Measures to Focus on: The narrow gap between the 10th and 90th percentile in CMS readmission and mortality measure rates suggests that even a minor decline or improvement in the measure performance can significantly impact the measure group score. Analyzing this trend and understanding the incumbent performance in all individual measures can be a very complex process for Hospitals. However, Dexur has developed CMS Star Rating simulations backed by AI which help Hospitals crunch through hundreds of millions of combinations to create scenarios that show how to improve readmission and mortality measure performance to improve overall Star Rating.

Dexur’s CMS Star Rating simulations show how even a slight improvement in each measure can help the Hospital move to a higher percentile and impact the Group Summary Score. Hospitals can use this tool to create multiple simulations with changes in all measure groups to see how the overall Star Rating is impacted. Dexur’s AI simulations offer healthcare providers a potent resource to simulate various scenarios, evaluate potential outcomes, and make informed decisions based on data. Providers can use this tool to move towards a higher performance percentile.

Set Goals to Streamline Healthcare Quality Improvement: As the performance range narrows, hospitals must strive for continuous improvement to improve outcomes. Even a slight decline in measure performance can significantly impact Star Ratings and other quality programs. Dexur’s robust analytics platform brings a solution to this problem by helping healthcare providers to set strategic, data-informed goals, based on their simulations and the priorities.

Track Interventions and see if they are improving measures: When the performance percentiles are so tight, its hard to know if the interventions that hospitals make are actually having an impact. Dexur’s platform tracks the events and interventions and quantifies the impact it may have had on the measure.

Identify Risk Factors that impact measures : With less variability in performance, healthcare organizations should focus on identifying specific areas of weakness. Without the latest data, most healthcare providers may find it challenging to identify the key measures to target and yield significant improvements in patient outcomes. Dexur brings in a breakthrough approach where it boils the ocean on one of the largest claims databases to come up with Real World Evidence (RWE) based Hospital specific risk factors and their Hospital, National and State benchmark comparisons.

Identify Best Practices: Healthcare organizations should engage in identifying best practices to avoid decline in the performance of readmission and mortality measures. Targeted interventions to address areas of weakness and identify best practices can improve performance. However, Dexur’s dedicated research team continuously investigates the best practices with its evidence-based approach to enhance quality outcomes that feed into CMS Star Ratings and other quality programs. With access to our healthcare research and analytics, healthcare providers gain access to a wealth of knowledge and research.

The narrow gap between the 10th and 90th performance percentiles of CMS readmission and mortality measures suggests a chance for providers to improve their healthcare quality and outcomes. Healthcare providers should embrace this trend as an opportunity to drive continuous improvement, identify areas for targeted interventions, and actively establish best practices. By leveraging Dexur’s data and software solutions to adopt successful strategies, hospitals can strive to provide the best possible care and further narrow the performance gap, ultimately leading to better patient outcomes across the healthcare system.