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Need to Know: SNFPPRM  

October 2019 officially opened the door for the new Skilled Nursing Facility Potentially Preventable Readmission Measure (SNFPPR) posted on Nursing Home Compare, and is now included in the provider performance scores.

The Annual Claims-Based Measure refresh includes the inaugural posting of provider performance scores for the Potentially Preventable Readmissions (PPR) Measures, which were previously suppressed. The updates will be posted in November once the review and correct period is closed for providers.

It is important to note that there are Potentially Preventable Readmission Measures for Inpatient Rehabilitation Facility (IRF), Long-Term Care Hospital (LTCH), and Home Health (HH) QRPs, as well, and will be posted on the respective compare sites, per the IMPACT Act requirements.

CMS defines a PPR to be a readmission in which the principal diagnosis coded on the claim is included on CMS’ list of PPR diagnoses. CMS has grouped these PPR diagnoses based on clinical rationale, as follows:

  1. Inadequate management of chronic conditions
  2. Inadequate management of infections
  3. Inadequate management of other unplanned events
  4. Inadequate injury prevention

The PPR measures in the SNF, IRF, LTCH, and HH QRPs are outcome measures that reflect readmission rates for patients who are readmitted to a hospital for a reason that is considered unplanned and potentially preventable.

PPRs are a subset of all-cause unplanned readmissions. CMS had previously publicly reported all-cause unplanned readmission measures for IRFs and LTCHs, and is currently using the SNF all-cause readmission measure (NQF #2510) for the SNF Value-Based Purchasing Program. However, because all-cause unplanned readmissions among the Medicare population are common and costly occurrences, focusing readmission measures on readmissions that are more likely to be preventable with high-quality care may allow providers to focus on conditions considered more actionable.

The potentially preventable 30-day post-discharge readmission measures for SNFs, IRFs, LTCHs, and HHAs assess readmissions during a 30-day period after discharge from the post-acute care provider. Another measure, the potentially preventable within-stay measure for IRFs, assesses readmissions during the IRF stay. These PPR measures are calculated using Medicare Fee-ForService claims and do not require any data collection on the part of providers.

Publicly reported measures should be reliable enough to adequately distinguish between high- and low-quality providers. CMS conducted extensive testing to assess the reliability of the PPR measures with methods commonly used for similar measures. As a result of this testing, CMS will publish the provider’s potentially preventable readmission rate and its performance category – whether the provider’s rate is “better than the national rate,” “worse than the national rate,” or “no different than the national rate.” CMS will also publish confidence intervals, measures of the uncertainty surrounding the provider’s rate, which are used as the basis for the performance categories.

Additional Resources and Information from CMS:

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Leadership Considerations:

Now more than ever, it is vital to have staff focused on competencies related to acute changes in resident condition and avoidable hospital transfers. See below for INTERACT training and resources to support your team:

A quality improvement program that focuses on the management of acute change in resident condition. View recent publications, download valuable tools, learn about training, and more. Learn more>

Clinical and operational leaders need to provide streamlined tools and resources to meet the ongoing challenges when meeting the Readmission Measure.                      Go shopping>

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Pathway Health provides your organization the insight, expertise and knowledge to help ensure quality clinical outcomes to reach your desired goals. Visit pathwayhealth.com or 877-777-5463.

 

Susan LaGrange, RN, BSN, NHA, CDONA, FACDONA, CIMT
Director of Education