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Anthony Cirillo

AHCA Introduces New Methodology for Calculating Hospital Case-Mix

By November 7, 2012

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The American Health Care Association will employ a new, proprietary methodology for calculating case-mix adjusted hospitalization metrics for its members in its national Quality Initiative.

The hospital readmission measure uses Minimum Data Set data and unique analytics to calculate case-mix adjusted hospital readmission rates.

As hospitals are penalized monetarily by the federal government if their readmission rates are too high, nursing home partners that keep readmission rates down will be more highly valued than ever as provider partners.

Says David Gifford, MD, MPH, senior vice president of quality and regulatory affairs at AHCA - "These analyses help skilled nursing centers focus on improving care for their residents. They also help centers demonstrate their value to hospitals, insurers and physician groups," Gifford said.

The Long-Term Quality Alliance (LTQA) issued a white paper dealing with preventable hospitalizations. Here are the action steps they outline:

  1. Define the domain as potentially preventable hospitalizations, as opposed to potentially preventable hospitalizations from a particular setting or potentially preventable readmissions within a particular time period.

  2. Define as precisely as possible the population of frail and chronically ill adults and older people who are receiving long-term services and supports.

  3. Begin a process to develop appropriate measures or measure-based procedures to identify potentially preventable hospitalizations in the LTQA population.

  4. Advocate with researchers and funders for rigorous studies to test the validity of existing and new measures of potentially preventable hospitalizations for frail and chronically ill adults and older people who are receiving long-term services and supports.

  5. Monitor and advocate with CMS the positive and negative effects on frail and chronically ill adults and older people of programs intended to reduce potentially preventable hospitalizations.

  6. Identify ways to help clinicians who make decisions about hospitalizations for frail and chronically ill adults and older people in various settings understand current and new programs intended to reduce potentially preventable hospitalizations, the rationales for these programs and the measures that are or will be used to evaluate their effectiveness.

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