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3.16.2020 Plan All-Cause Readmissions Which risk weights are assigned to index hospital stays discharged to skilled nursing care when calculating expected readmission rates for the Medicare product line?

For the Medicare product line only, a “Skilled Nursing Care Stratification” was added to highlight the readmission rate among non-outlier Medicare beneficiaries who were discharged from the hospital to skilled nursing care. An index hospital stay discharged to skilled nursing care experienced by a non-outlier Medicare beneficiary is reported in several places and receives two sets of risk weights.

The tables in the PDF (https://www.ncqa.org/wp-content/uploads/2020/03/20200312_2020_PCR_Tables.pdf) illustrate assignment of risk weights for index hospital stays among two hypothetical Medicare beneficiaries meeting all other measure criteria (e.g. non-outlier, continuously enrolled, etc.). Index Hospital Stay #2 for member 1101 and Index Hospital Stays #1 and #2 for member 1202 are discharged to skilled nursing care.

Table 1 shows that these index stays are assigned the standard set of risk weights for reporting in Table PCR-A-1/2/3 and Table PCR-B-3. Do not assign the skilled nursing care risk weights for the stays in Table PCR-A-1/2/3 and Table PCR-B-3.

Table 2 shows that these same index stays are assigned the skilled nursing care risk weights for reporting the “Skilled Nursing Care Stratification” in Table PCR-C-3. Do not assign the standard set of risk weights for the stays in Table PCR-C-3.

Index hospital stays that are not discharged to skilled nursing do not need to be assigned the skilled nursing care risk weights and are not reported in the “Skilled Nursing Care Stratification” in Table PCR-C-3.  Index Hospital Stays #1 and #3 for member 1101 are examples of events that do not need to be assigned the skilled nursing care risk weights and are not reported in the “Skilled Nursing Care Stratification”. The “Skilled Nursing Care Stratification” applies to the Medicare product line only and index hospital stays among other product lines do not use the skilled nursing care risk weights.



 

HEDIS 2020