This Hedis Measure
Assesses the rate of unplanned acute inpatient and observation stays within 30 and 60 days of discharge from a skilled nursing facility (SNF). NCQA specifies that plans report a predicted probability of hospitalization as well as observed rates, to account for a member’s prior and current health, among other factors. The observed rate and predicted probability are used to calculate a calibrated observed-to-expected (O/E) ratio that assesses whether plans had more, the same or fewer hospitalizations after SNF discharge than expected, while accounting for incremental improvement across all plans over time. The O/E ratio is multiplied by the post-SNF hospitalization rate across all plans to produce a risk-standardized rate that allows national comparison.
Why It Matters
Skilled nursing facilities provide extended rehabilitative care beyond care provided during an acute hospitalization. Medicare beneficiaries requiring SNF services are among the most vulnerable, and a high rate of patient admissions post-SNF discharge may indicate inadequate quality of care in the hospital and/or a lack of appropriate care coordination. Unplanned hospitalizations after discharge from an SNF are associated with negative outcomes, including increased mortality, for Medicare beneficiaries. Unplanned admissions can be prevented by standardizing and improving coordination of care and increasing support after SNF discharge.1,2
Results – National Averages
Total: 30 Day Rate
| Measure Year | Medicare HMO | Medicare PPO |
|---|---|---|
| 2022 | 12.9 | 12.3 |
| 2021 | 12.8 | 12.1 |
| 2020 | 12.6 | 12.1 |
Total: 60 Day Rate
| Measure Year | Medicare HMO | Medicare PPO |
|---|---|---|
| 2022 | 20.1 | 19.5 |
| 2021 | 20.1 | 19.1 |
| 2020 | 19.4 | 18.8 |
§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.
References
- Burke, R.E., E.A. Whitfild, D. Hittle, S.J. Min, et al. 2016. “Hospital Readmission From Post-Acute Care Facilities: Risk Factors, Timing, and Outcomes.” J Am Med Dir Assoc 17(3):249–55. doi: 10.1016/j.jamda.2015.11.005
- Hakkarainen, T.W., S. Arbabi, M.M. Willis, G.H. Davidson, D.R. Flum. 2016. “Outcomes of Patients Discharged to Skilled Nursing Facilities After Acute Care Hospitalizations.” Ann Surg 263(2):280–5. doi:10.1097/SLA.0000000000001367