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These articles are from Dexur's Rural Health Newsletter, which is focused on Rural Healthcare’s operations, technology, quality, safety, risk, compliance and learning topics. Please email DexurRuralHealth@dexur4.com to join this newsletter and receive updates (not more than once per week).


Dexur Rural Health Insights

Share Your 2026 CMS Star Rating Improvement Plan and Compare It With Dexur's AI Simulations To See If You Are On The Right Track

Since the 2024 CMS Star Rating Preview reports are already out and the 2025 CMS Star Rating performance period for all measures is over, hospitals now need to focus on the 2026 CMS Star Rating. Dexur had a 98% accuracy rate in predicting 2023 CMS Star Ratings, and early indications based on our customer feedback suggest we are likely to achieve a similar accuracy rate for 2024.

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Challenges In Aligning Physician Incentives to Quality Metrics and Quality Programs and How To Do It Correctly

Aligning physician incentives with quality metrics and programs such as CMS Star Ratings, HRRP, and VBP is crucial for improving healthcare outcomes and operational efficiency. However, significant challenges include time lags in published metrics, the inclusion of out-of-hospital data, the complexity of risk adjustments, and sophisticated algorithm requirements. Dexur addresses these issues by providing comprehensive patient journey data from Medicare claims, performing advanced risk adjustments, and ensuring accurate algorithm implementation. By tracking internal observed rates monthly and bridging them to final CMS published values, Dexur helps hospitals align incentives accurately, enhancing care quality and operational performance.

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Necessity Vs Sufficiency: Can Dexur Help Improve CMS Star Rating, VBP, Leapfrog, and Other Quality Programs?

Dexur provides essential systems such as data analysis, simulations, goal setting, and intervention tracking, making it indispensable for hospitals. However, Just as a marathon runner needs both a stopwatch and rigorous training or a CFO needs financial reports and strategic action, hospitals need Dexur’s insights and a committed effort from their staff. Without Dexur’s guidance, predictions, and simulations, hospitals would struggle to monitor progress, set SMART goals, and track interventions effectively. However, the true success of these initiatives also hinges on the hospital's commitment to change, strategic implementation, collaborative efforts, and continuous adaptation.

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How to Present Your Hospital CMS Star Rating to Your C Suite and Board

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Presenting your hospital's CMS Star Rating to the C Suite and Board involves a strategic approach that includes a thorough analysis of past performance and a forward-looking plan for improvement. In Part 1, hospitals should analyze past data to identify domains and measures that have improved or declined, delve into specific measures to understand their nuances, illustrate how small changes can have significant impacts, and bridge the gap between internal hospital data and out-of-hospital impacts. Part 2 focuses on establishing a comprehensive improvement plan, emphasizing the necessity of simulation-based improvements, setting SMART goals, developing intervention plans, and maintaining a monthly cadence for progress reporting. Utilizing Dexur’s AI-powered tools, hospitals can effectively identify improvement areas, simulate outcomes, set specific objectives, track interventions in real-time, and ensure continuous alignment with quality improvement goals through regular updates and early warning alerts.

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How are Hospital CMS Star Rating & VBP Programs Co-related?

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Introduction

The Centers for Medicare & Medicaid Services (CMS) Star Rating and the Value-Based Purchasing (VBP) Program are pivotal in shaping healthcare quality and reimbursement. Both programs aim to improve patient care by incentivizing hospitals based on performance metrics. This article delves into the potential correlation between a facility's CMS Star Rating and its financial impact under the VBP Program, hypothesizing that there may be a tangible link between the two.

Background

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If Your 2024 Published Readmissions and Mortality Measures Are Lower than 2023, then 2025 Could Be Even Worse

Hospital performance metrics for readmissions and mortality under CMS Quality Programs are critical for improving CMS Star Rating, VBP, HRRP, and other programs. These metrics are evaluated using data from a rolling three-year period, which shifts annually to include the most recent data while excluding the oldest.

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Case Study: Dexur’s AI Quality Platform and NRC's Patient Experience Partnership Enhances Quality at Good Samaritan

Good Samaritan, a community healthcare Hospital in Vincennes, Indiana, in collaboration with Dexur and National Research Corporation (NRC), has advanced its capabilities in measuring and improving patient experience and quality metrics. This case study delves into the transformative effects of integrating Dexur’s data analytics with NRC’s patient survey expertise, enhancing Good Samaritan’s performance across various critical healthcare quality metrics.

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Why Your Internal Hospital Quality Metrics Are Likely To Be Inaccurate and How Dexur’s Data Audit Can Help Validate Them

Imagine you're in a routine leadership meeting, presenting your hospital's latest quality metrics from your internal dashboard—readmission rates, and mortality metrics, all seemingly well under control. The team is satisfied and confident in the data's accuracy and the hospital’s performance. Fast forward to the release of the Centers for Medicare & Medicaid Services (CMS) final results, and the situation unfolds quite differently. Suddenly, there’s a stark contrast—CMS data indicates a decline in performance. The board is stunned, the C-suite is questioning the data, and you're left wondering where the discrepancy lies.

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Risk Factors Impacting Specific Readmission and Mortality Measures Can Be Leveraged by Medical Coding and Quality Improvement Teams

Medical coding and quality improvement teams can effectively leverage data on risk factors that influence specific readmission and mortality measures to enhance healthcare outcomes. By ensuring accurate medical coding, these teams can identify discrepancies and opportunities for improvement, leading to more precise documentation and better resource allocation. Quality improvement teams can utilize this data to target interventions for high-risk patient cohorts, thereby reducing readmission rates and improving care quality. Collaboration between coding and quality teams, informed by comprehensive risk factor analysis, is crucial in driving operational efficiencies and enhancing patient care. This synergy not only supports financial performance through improved coding and reimbursement accuracy but also fosters a culture of continuous quality improvement within healthcare organizations.

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48% of SSI Colon Hospital Acquired infections are likely to occur within 10 days of Admission

Importance and Background on Surgical Site Infections in the Colon

Surgical Site Infections (SSI) following colon surgery present a significant challenge in healthcare. They adversely affect patient recovery and impact hospital quality metrics. These infections not only lead to longer hospital stays and increased costs but can also result in severe, life-threatening complications. Therefore, it is essential to focus on enhancing infection control measures and implementing robust post-surgical care protocols to effectively prevent and manage these infections.

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Dexur White Paper: How CEOs, CFOs, CMOs, & CQOs Can Cut Technology Costs And Improve CMS Star Ratings and Quality Programs

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This white paper highlights how healthcare organizations can significantly reduce costs and enhance operational efficiency by consolidating multiple functions into a single platform with Dexur's AI Unified Quality and Risk Management software. Dexur offers an AI-powered unified system for managing quality, safety, risk, and incidents. By adopting Dexur's integrated software, healthcare providers can streamline their operations and achieve a higher standard of care at a reduced expense.

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Key Pathogens Influencing CAUTI Infections in Hospitals

Catheter-associated Urinary Tract Infections (CAUTI) greatly influence both patient outcomes and the financial aspects of healthcare, with Dexur being a key contributor in data analytics to improve healthcare safety and quality. Leveraging hospital data reported to the CDC's NHSN, Dexur identifies key pathogens contributing to CAUTI, highlighting the top five: Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus faecalis, and Proteus mirabilis. Each of these pathogens poses distinct challenges in their treatment and prevention. Through Dexur's detailed analysis, the development of targeted infection control protocols is facilitated, and the process supports both Root Cause Analysis (RCA) and the implementation of Corrective and Preventive Actions (CAPA). Such a strategy is crucial for the effective management of CAUTI, with the ultimate goal of enhancing patient outcomes and the efficiency of healthcare services.

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Texas Hospital Association Endorses Dexur to Provide Quality, Safety, and Risk Solutions to Texas Hospitals

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The Texas Hospital Association (THA) has endorsed Dexur, an AI-driven unified Quality, Safety, Risk, and Incident Management software, to support its member hospitals. This partnership is highlighted by THA's Alex Huff and Dexur's CEO, Nik Rao, who emphasize the alignment of Dexur's advanced technological capabilities, including AI-driven analytics and comprehensive data management, with THA's goals for enhancing healthcare quality and efficiency. Dexur's platform will offer THA hospitals a suite of tools for detailed program-to-case analysis, predictive insights, and strategic planning aimed at improving patient care outcomes and operational performance at a dramatically cost-effective price.

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A Significant Portion of Readmitted Patients Stay for only 1 or 2 Days

Readmissions are a critical quality metric for hospitals, significantly impacting financial and reputational outcomes under the Hospital Readmissions Reduction Program (HRRP) and the Centers for Medicare & Medicaid Services (CMS) Star Rating system. The HRRP imposes penalties on hospitals with higher-than-expected readmission rates for specific conditions, aiming to incentivize improvements in hospital discharge planning and post-discharge care. Similarly, the CMS Star Rating system evaluates hospitals on various performance measures, including readmission rates, to help consumers compare hospitals more easily. High readmission rates can lead to reduced Medicare payments and lower star ratings, which may influence patient choice and hospital revenue.

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How Clinical Peer Reviews Can Not Only Meet Accreditation Requirements but Also Drive Improvements in Quality Program Outcomes

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Peer review is a critical component in the accreditation and quality assurance processes for healthcare organizations. The Joint Commission (TJC), the Centers for Medicare & Medicaid Services (CMS), Det Norske Veritas (DNV), and the National Committee for Quality Assurance (NCQA) each have specific expectations regarding peer review processes.

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Webinar: Dexur Releases its Annual 2024 CMS Star Rating Predictions

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Dexur makes its annual predictions on CMS Star Ratings before CMS Star Ratings are published in July of every year. In 2023, Dexur had a 98% accuracy rate in its annual prediction rate. To get an understanding of your Hospital’s increase in decrease of your Star Rating, you can search for your Hospital’s prediction via the Hospital Search Function or you can also go through any Hospital’s CMS Star Rating predictions direction by browsing through state pages. To get the actual Star Rating prediction and a glimpse of the key drivers of the performance, you can also reach out to Dexur by email dexur@dexur.com.

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Emergency Departments Play a Critical Role In Managing Readmissions

Readmissions to hospitals, particularly within 30 days of discharge, serve as a critical measure for evaluating the quality and effectiveness of healthcare services. The Hospital Readmission Reduction Program (HRRP) and the Centers for Medicare & Medicaid Services (CMS) Star Rating system place significant emphasis on readmission rates as indicators of hospital performance. These measures directly impact hospitals' financial health through penalties and influence their reputation through public reporting.

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Why are Inpatient THA / TKA Readmissions and Complications Increasing?

Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are critical measures in assessing the quality of care provided by healthcare facilities, particularly in the context of Medicare's value-based care models. These procedures are common among the elderly population, who are the primary beneficiaries of Medicare. The rates of 30-day readmission and complications after THA/TKA are significant indicators of the quality and effectiveness of perioperative care, postoperative management, and the overall health system's ability to provide coordinated care. These metrics directly impact various Centers for Medicare & Medicaid Services (CMS) Quality Programs, such as CMS Star Rating and the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with higher than expected readmission rates for certain conditions and procedures, including THA/TKA.

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How the SEP1 Chart Abstraction Measure can be Integrated into CMS Star Ratings and VBP

The SEP1 chart abstraction measure, a critical component in healthcare quality assessment, plays a pivotal role in evaluating the efficiency and effectiveness of sepsis management in healthcare facilities. Sepsis, a life-threatening response to infection leading to tissue damage, organ failure, and potentially death, requires timely and precise treatment. The SEP1 measure is designed to quantify the quality of this treatment by tracking various parameters, such as the timeliness of antibiotic administration and the completeness of sepsis care.

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What are the Top Pathogens Impacting CLABSI Infections in Hospitals

Central Line-Associated Bloodstream Infections (CLABSI) remain a significant challenge in healthcare settings, directly influencing patient outcomes and healthcare costs. CLABSI, a severe infection occurring in patients with central venous catheters, poses risks that extend beyond immediate health concerns, impacting hospital ratings and reimbursement rates.

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Dexur Acquires Chart Abstraction Software and Operations from Indiana Hospital Association, Enhancing AI-Driven Quality and Risk Management

Dexur, a leading provider of AI-driven unified quality and safety, risk, and incident management software, will acquire the Comparative Outcome Profile (COP) chart abstraction software from the Indiana Hospital Association (IHA). This strategic move aims to bolster Dexur's capabilities in offering comprehensive, AI-powered solutions to healthcare organizations.

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How Medical Coding Can Impact Your Risk Adjusted Rates and Ultimately your CMS Star Ratings, HRRP, VBP and other Quality Programs

Medical coding plays a crucial role in determining risk-adjusted rates, directly influencing a hospital's performance in quality programs like CMS Star Ratings, HRRP, and VBP. Risk adjustment is essential for equitable evaluations, especially in treating complex patient cases. Detailed coding impacts these risk-adjusted metrics, as seen in a case study of Acme Hospital, where coding accuracy significantly affects quality measures and assessments. A comparative analysis of Acme and Vibrant Hospitals further highlights the importance of precise coding practices in reflecting patient care complexity and ensuring fair evaluations in healthcare quality programs.

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The Median Critical Access Hospital Needs to Reduce COPD Mortality by 1 per Year to get to the Top 90th Percentile

Critical Access Hospitals (CAHs) are essential to the healthcare infrastructure, particularly in rural and remote areas. They often serve as the primary, and sometimes only, source of healthcare for their communities. One of the key performance indicators for these hospitals is the management of Chronic Obstructive Pulmonary Disease (COPD) mortality. This measure not only reflects the quality of care provided but also significantly influences the CMS Star Rating's mortality domain.

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How Rural Hospitals Can Leverage Telehealth to Improve Mortality Measures Impacting CMS Star Ratings

For rural hospitals mortality measure group weightings could range from 22%-39% and therefore have a significance on CMS Star Ratings. Specifically, measures related to heart failure, Acute Myocardial Infarction (AMI), Coronary Artery Bypass Grafting (CABG), Chronic Obstructive Pulmonary Disease (COPD), and Pneumonia are integral to the mortality measure group in CMS Star Ratings. Addressing these specific conditions effectively can lead to improved outcomes, directly impacting a hospital's CMS Star Rating. Telehealth strategies emerge as innovative solutions to confront these challenges, offering rural hospitals a pathway to enhance patient outcomes in these critical areas and, subsequently, improve their CMS Star Ratings.

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All MBQIP Measures in One Place

The Medicare Beneficiary Quality Improvement Project (MBQIP) is a voluntary quality improvement initiative aimed at promoting better healthcare outcomes for patients treated in critical access hospitals (CAHs), which are often located in rural areas. MBQIP provides an opportunity for small hospitals to report on quality and outcomes data, fostering a culture of quality improvement and enhancing rural healthcare delivery.

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Small Size as an Advantage for Rural Hospitals: Providing Individualized Patient Care is Easier to Achieve

The capacity for individualized patient care is a significant metric for healthcare quality and outcomes. In smaller rural hospitals, the scale of operations lends itself to a more personalized approach, particularly when managing chronic conditions such as heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and chronic obstructive pulmonary disease (COPD). For these conditions, a typical rural hospital may see fewer than 200 patients over three years as per Centers for Medicare & Medicaid Services (CMS) measures, averaging about five patients monthly. This volume is distinctly manageable compared to larger systems, which often struggle to provide individualized follow-up care due to higher patient numbers.

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Small Size as an Advantage for Rural Hospitals: Smart Use of Technology + Manual Approaches

In the healthcare industry, large organizations face significant challenges due to their size and complexity. Cross-departmental coordination is a critical requirement to mitigate risk, often leading to bureaucratic inertia. Large hospitals rely on massive, centralized systems designed for economies of scale, but these can be slow and costly to alter. When faced with problems, these institutions typically turn to technology as a solution, inflating capital expenditure (Capex) budgets and return on investment (ROI) benchmarks, thus creating barriers to change.

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Small Size as an Advantage for Rural Hospitals: Achieve Scale at the Organization Level Not at the Functional Department

Rural hospitals, with their smaller size, often face the challenge of limited budgets and resources compared to larger healthcare institutions. Large organizations typically have the luxury to allocate distinct technology and application budgets across various functional departments like Quality, Compliance, Risk, and Learning. Each department independently evaluates and selects applications tailored to its unique needs, an approach that often leads to additional spending on system integration to ensure cross-departmental compatibility.

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Rural Health and The Challenges of Low Case Volume: MRSA Case Study

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Rural hospitals are essential cornerstones of the communities they serve, yet they face unique challenges in assessing the quality of healthcare services they offer. One significant challenge arises from low patient volumes which, while potentially indicative of effective healthcare or healthier populations, can distort quality metrics. This distortion makes benchmarking performance against national standards a complex endeavor. Through the lens of MRSA (Methicillin-resistant Staphylococcus aureus) infections, we can gain valuable insight into this issue.

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