As national health care reforms continue to be implemented, there has been increased attention on patient outcomes from hospitalizations.  Beginning in 2005, Congress required the inclusion of hospital outcome and efficiency measures in the Hospital Inpatient Quality Reporting Program. Beginning in 2008, these outcome measures were publicly available through the HosptialCompare website.

The 2010 Patient Protection and Affordable Care Act (ACA) requires the development of additional hospital outcome measures. More importantly, beginning last October 2012, the ACA imposed financial penalties for “excess” or avoidable hospital readmissions through the Hospital Readmissions Reduction Program. The penalties for avoidable readmissions currently only apply to readmissions for Medicare patients with diagnoses of acute myocardial infarction (AMI), heart failure (HF), and pneumonia. However, beginning in October 2014, they will be expanded to include diagnoses of elective total hip or knee replacement, and congestive obstructive pulmonary disease (COPD).

Meanwhile, beginning July 2013, the Centers for Medicare & Medicaid Services (CMS) now requires the public reporting of the following hospital outcome measures through the Hospital Inpatient Quality Reporting Program:

  • Risk-standardized outcome measures:

* 30-day mortality measures for acute myocardial infarction (AMI), heart failure  (HF), and pneumonia

* 30-day readmission measures for AMI, HF, pneumonia, total hip and/or total knee arthroplasty (THA/TKA), and hospital-wide readmission (HWR)

* A complication measure for THA/TKA

  • Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators
  • Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction measure

CMS has published an extensive Frequently Asked Questions (FAQs) about these measures, including how they were selected, and how each hospital should use and publicly report these measures.

The mortality and readmission measures are “all-cause” measures because from a patient perspective, these are undesirable outcomes, regardless of the cause.  

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