As part of the final rule for the 2020 Inpatient Prospective Payment System, the Centers for Medicare and Medicaid Services ordered the adoption of the 30-day readmission measure across the hybrid hospital by 2023.
That measure, a hybrid of electronic health record data and claims data for patients 65 and older who have Medicare as their payer, should be publicly disclosed at Hospital Compare by 2025, explained Kristen Beatson, director of electronic measures at the Quality report. Medisolv software provider, during a recent HIMSS20 digital presentation.
Still, only 150 hospitals participated in the 2019 voluntary pilot program, and many found their data to be incomplete.
“When it comes to hybrid measures, you must be good and accurate and have complete claims data,” Beatson said during his presentation, Hybrid Measures: What the Hell Are They? How do they work?
Regarding EHR data, “You must also have complete and accurate data to be successful.”
Hybrid measurements are advantageous, Beatson said, because they provide a more accurate view of hospital performance. The clinical data extracted from the EHRs incorporates the severity of the patient’s illness in a way that the billing system and claims data do not.
“The more severe the patient is, the more likely he is to be readmitted. That needs to be taken into account when looking at the readmission rate,” Beatson said.
The readmission rate for a hospital that does not serve many critically ill patients should be different from that for a sicker patient population, he continued.
Beatson said it is important for hospitals to prepare for hybrid measurement requirements, as including incorrect data can skew the numbers of a facility. Results are not returned for months, making it difficult to know in advance if vital information is missing.
Hospitals face several common obstacles in implementing hybrid measures. One of the most significant is mapping: since providers measure clinical data, such as patient weight or blood pressure, at various points during treatment, it is vital to track where that information is stored.
“I strongly suggest that you now have a process to monitor that data and improve it well in advance of the required shipping period,” Beatson said.
Beatson shared several lessons learned from working with 69 hospital clients during the pilot program, warning that typos and unexpected code changes can overwrite essential data or make it unreadable.
“That is why you want to participate in voluntary reporting, so you can solve these things well in advance,” he advised.
Although the next voluntary measurement period does not begin until July 2021, she said: “You have all the tools to do what you need to do to start mapping, schedule meetings at your facility, and get that annual report processed in place and incorporate the [clinical] data collection and monitoring of their processes. ”
“The sooner you do it, the easier it will be in the long run,” he said.
Kat Jercich is a senior editor at Healthcare IT News.
Healthcare IT News is a publication of HIMSS Media.