Following is the full conversation of Episode 2 of the Hospital Readmissions Reduction Podcast.
Michael: Welcome to the Hospital Readmissions Reduction podcast brought to you by BESLER Consulting. This is the podcast for hospital leaders seeking insights and strategies they need to help reduce readmissions at their organizations. I’m Mike Passanante your host for this podcast and today we’re going to talk about the QualityNet Hospital-Specific Report. Now some of you may be very familiar with that report, work with it regularly, others of you may be saying, “I don’t know what that is or why we’re talking about it,” and that’s fine. By the end of this podcast, you’re going to have a great sense as to what the QualityNet Report is, what you can do with it and why you should be using it. To help us understand that topic, once again we’re going to be speaking with Dr. Edward Niewiadomski. Dr. Niewiadomski has over three decades of experience in direct patient care and healthcare administration. He is the former Senior Vice President of Medical Affairs and Chief Medical Officer for a community, acut-care facility in New Jersey. Welcome back, Dr. Niewiadomski.
Dr. Niewiadomski: Thank you, Michael. Good to be back.
Michael: To get us started, what is the hospital-specific report and why does it exist?
Dr. Niewiadomski: Well, I can answer the first question, I can’t answer the second question as to why it exists. We’re still trying to figure that out. But Medicare has contracted with QualityNet.org and QualityNet.org is the organization that has been charged with generating hospital-specific data as it relates to the core measures involved in the Hospital Readmissions Reduction Program – the HRRP. The QualityNet Report is essentially a compilation of data of cases and outcomes that are under the five core measures that occurred between July 1, 2010 through June 30, 2013. This report provides us, within each core measure, the number of eligible discharges in each of the core measures, the number of readmissions for your particular hospital for each core measure, predicted readmission rate, expected readmission rate, excess readmission ratio, and the national crude readmission rate. Now let me just digress for one moment.
Medicare provides this report, the QNet file, through QualityNet.org. However, CMS is on the record of stating that your hospital, individual hospitals, cannot independently calculate their excess readmission ratio using only their data, because they require claims data from Part A and Part B on a national level. And this national-level data is not available to your specific hospital. What that translates into is that essentially your hospital is penalized not only on your readmission rate above a certain threshold, but also on how you fair with the rest of your peers within your market. So even though you may think you are doing okay in reducing readmissions, if your peer groups does somewhat better, your penalty may not go away, it may actually go up even though you had some small gains in your readmission reduction. So this is based, for example, on a curve like when you were back in college when you were taking calculus. You take a test and your scores are based not on your particular score, but how the rest of the crew did on that particular exam.
Michael: I don’t think I was on the top part of that curve for calculus.
Dr. Niewiadomski: That’s why I mentioned calculus because I wasn’t either.
Michael: You have talked a bit about what’s in the report. Could you just remind everyone who’s listening what those core measures are that you referred to?
Dr. Niewiadomski: Yes. Currently, there are five core measures: acute MI, heart failure, pneumonia, COPD, and total joint – total hip and knee replacement. They are the current five that weigh in for the fiscal year 2015 penalty. However, currently CMS has identified an additional core measure which will weigh in for the fiscal year 2017 which is coronary artery bypass grafting (CABG). Now even though that CABG will be calculated for fiscal year 2017, the outcomes for coronary artery bypass grafting are already being tabulated as we speak. So the data collection period which will then appear in your QNet file is data period from July 1, 2012 through June 30, 2015. So even though we’re not being penalized or reviewed at this point on that core measure, the outcomes are already being tabulated.
Michael: So that’s a great lead for my next question, because it seems like the QNet file is really delivering retrospective data. So you as a hospital, you have this file; is it really actionable? What can you do with this information?
Dr. Niewiadomski: You’re exactly right, it is clearly retrospective. It’s a rolling three-year period. The current penalties for 2015, the review period was 7/1/2012 through 6/30/2013, as we stated. However, you need to have at least some handle on what happened historically so as to identify opportunities, where to look to focus your readmission reduction strategies. For example, if you are able to figure out where your disposition of patients were, and then the readmission originated from say a particular skilled nursing facility, or originated from a home health agency in the community, you can then look at what transpired during that phase in that post-discharge period, and go back and implement opportunity improvement strategies.
The QNet file is a very difficult file to manipulate and gain any sort of reasonable action items from it. I would bet that those individuals who are actually listening to our podcast, who are interested in readmissions and certainly readmission reduction strategies, they have to rely on others within the organization to provide them data from the QNet file. This could be a very labor-intensive process of gleaning meaningful data out of the QNet file and making heads or tails of it out of it to provide to the clinical team so they can focus their readmission reduction initiatives.
Michael: Clearly, yes. So hospitals have access to this report on QualityNet.org, right?
Dr. Niewiadomski: Yes.
Michael: When does it publish?
Dr. Niewiadomski: The most current data point will be republish now in July, August of 2015, and that will incorporate data from 2014.
Michael: Great. So you have this hospital-specific report, obviously that’s what CMS is using to calculate your penalties. I’m wondering, does it really give you the full picture? Is it easy to understand? Can you really use it to focus in on everything you need to do to reduce readmissions. What else might you need? What other data points?
Dr. Niewiadomski: Well, the short answer to your question is no. Unfortunately, it doesn’t give you all and it’s not all-telling, and it doesn’t give you all the information that you need to completely understand your readmission penalty, number one. Most importantly, from a clinical perspective, it doesn’t identify some critical disposition issues that occur in the post-discharge period. For example, you need to really drill down and figure out where the patients went. If they went to home, what transpired there? Home healthcare agencies, which ones? The timeliness of initiation of that care plan in the post-discharge period, all of that is not available. You need to marry the data in the QualityNet file with the common working file from your Medicare patients. When you marry those two files, then you will start to see a complete picture of what is really playing into and factoring into your readmission problem within your particular organization.
Michael: Who in the hospital should be paying attention to what’s in this report?
Dr. Niewiadomski: That’s a great question, Michael, as far as who should be paying attention to the data in the QNet file. The most accurate answer, I believe, is everyone. We need to have this data available and readily accessible to those individuals who are charged with readmission reduction strategies. I’m a firm believer that it is truly an enterprise initiative if we’re going to have effective strategies with good outcomes and able to validate results. The data needs to be available, the teams need to be aware of outcomes so they know where to focus their resources and to be effective in their strategies.
Michael: Absolutely. Well, I think we all have a much better idea of what the QualityNet Hospital-Specific Report is all about now. Thanks again for your time today. It was great having you.