As part of the 2020 Inpatient Prospective Payment System final rule, the Centers for Medicare and Medicaid Services mandated adoption of the Hybrid Hospital-Wide 30-Day Readmission measure by 2023. That measure, a hybrid of electronic health record data and claims data for inpatients 65 or older who have Medicare as their payer, must then be publicly reported on Hospital Compare by 2025, explained Kristen Beatson, director of electronic measures at the quality-reporting-software vendor Medisolv, 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 we’re talking about the hybrid measures, you have to be good and accurate and have complete claims data,” said Beatson during her presentation, Hybrid Measures: What the Heck Are They? How Do They Work? With regard to EHR data, “you also have to have complete and accurate data in order to be successful.”
Hybrid measures are advantageous, Beatson said, because they provide a more accurate look at hospital performance. Clinical data extracted from EHRs incorporates the severity of patient illness in a way that the billing system and claims data do not. “The more critically ill the patient, the more likely they are to be readmitted. That needs to be taken into consideration when you’re looking at readmission rate,” Beatson pointed out.
The readmission rate for a hospital that doesn’t serve many critically ill patients should be different from that of one typically serving a sicker population of patients, she continued. It’s important for hospitals to prepare for the hybrid measure requirements, Beatson said, because including the wrong data can skew a facility’s numbers. The results aren’t returned for months, so it’s difficult to know ahead of time if vital information is missing.
Hospitals face several common obstacles when implementing hybrid measures. One of the most significant is mapping: Because providers measure clinical data, such as patient weight or blood pressure, at several points during treatment, it’s vital to track where that information is stored. “I strongly suggest you have a process in place now for monitoring that data and improving upon it well in advance of the submission period it’s required in,” said Beatson.
Beatson shared a number of 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 illegible. “This is why you want to participate in voluntary reporting, so you can figure these things out well in advance,” she advised. Although the next voluntary measuring period doesn’t begin until July 2021, she said, “You’ve got all the tools to do what you need to do to get the mapping started, to get meetings scheduled in your facility and to get that annual process in place and incorporate the [clinical] data collection and tracking into your processes.”
