Among seniors with Medicare and additional public coverage such as Medicaid, inflation-adjusted out-of-pocket payments for medical care decreased from an average of $1,253 in 2000 to $427 in 2014. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #500: Out-of-Pocket Health Care Expenses for Medical Services, by Insurance Coverage, 2000-2014.)
Inpatient Quality Indicators (IQIs): The Agency for Healthcare Research and Quality (AHRQ) has released ICD-9-CM v6.0 SAS QI and ICD-9-CM v6.0.1 WinQI software for the IQIs. SAS QI and WinQI ICD-9-CM software improvements include:
- Enhancements to select indicators for IQI
- APR-DRG Grouper version 33
- Application files now organized into separate folders for user Programs, Macros and Parameter Files for IQI (SAS QI only)
- Revised program and file names for improved usability (SAS QI only)
The software is available for download at: https://www.qualityindicators.ahrq.gov/Software/
Updates for Other Quality Indicators (QI) Modules
- PSIs: The PSI module of the v6.0 ICD-9-CM SAS QI and WinQI software has been temporarily removed from the AHRQ QI website. The PSI module will be re-released in spring 2017. The updated PSI module will be released in v6.0.2 ICD-9-CM. Additional information related to this release is available at https://www.qualityindicators.ahrq.gov/News/PSI_v6.0_SASQI_WinQI_Memo.pdf
- PQIs: The PQI module for v6.0 ICD-9-CM SAS QI and WinQI will be re-released in spring 2017 in v6.0.3 ICD-9-CM to update POVCAT values. For users running the risk adjustment program and using the optional feature of including poverty in the risk adjusted rates (instead of risk adjustment) calculations on v6.0 ICD-9-CM, the 2010 poverty rates are being used in the calculations.
- PDIs: The PDI module for v6.0 ICD-9-CM SAS QI and WinQI will be released in late spring 2017.
- The ICD-10 v7.0 ICD-10 CM/PCS software for SAS QI and WinQI will be released in late spring 2017. Please note that v7.0 of the software will not include risk adjustments and only supports data coded in ICD-10-CM.
- The version 5.0.3 Limited License APR-DRG Grouper package has been updated on the AHRQ QI website. The discharges from the fourth quarter 2013 through the third quarter 2015 assigned the grouper version 20 instead of the grouper version appropriate for the year and quarter, such as version 31 and 32. This only impacts the users who used “Version 5.0.3 (Limited License APR-DRG Grouper), February 2016” package to impute APR-DRG values to be used with SAS QI v5.0.x IQI module.
Improvements in patient safety led to fewer deaths from hospital-acquired conditions (HACs) from 2010 to 2015. Compared with the HAC rate in 2010, more than 37,000 fewer patients died from HACs in 2015. The improvement saved about $8.3 billion in 2015.
- Source: Agency for Healthcare Research and Quality, National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015: Interim Data From National Efforts To Make Health Care Safer.
Since December 2016, the following 2014 State databases have been released:
- State Inpatient Databases (SID)
○ 2014: South Carolina
- State Ambulatory Surgery and Services Databases (SASD)
○ 2014: New York and South Carolina
- State Emergency Department Databases (SEDD)
○ 2014: New York and South Carolina
In addition, the 2014 Nationwide Emergency Department Sample (NEDS) has been released.
About 3.1 million fewer hospital-acquired conditions occurred between 2010 and 2015. Most of the decline was due to a 42 percent reduction in adverse drug events, a 23 percent drop in pressure ulcers and a 15 percent reduction in catheter-associated urinary tract infections.
Source: Agency for Healthcare Research and Quality, National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015: Interim Data From National Efforts to Make Health Care Safer.
AHRQ: Removal of v6.0 PSI Module Software & Replacement with v6.0.2 PSI Software Package: Forthcoming May 2017Martina Dolan | March 13, 2017
This announcement is for all users of the AHRQ Quality Indicators (QIs) that all 6.0 versions of the Patient Safety Indicator (PSI) Software Package for SAS QI and WinQI were temporarily removed from the AHRQ website and will be replaced with a revised 6.0.2 version that addresses a number of issues identified. These issues are described in brief below. For more detailsvisit: https://www.qualityindicators.ahrq.gov/News/PSI_v6.0_SASQI_WinQI_Memo.pdf
Fixes to the PSI v6.0 ICD9CM Software include:
- Correction to the 2013 Reference Population
- Modified-Diagnostic Related Groups (MDRGs) 237 and 238 inclusion in the definition of surgical cases
- Reassignment of MDRGs 520 and 521
- Corrections to typographical errors in MDRG-specified risk factors
Enhancements to the PSI V6.0 ICD9CM Software include:
- Expanded array to assign Major Diagnostic Category (MDC) groups
- PSI 04 risk adjustment aligned with recent NQF re-endorsement (December 2016)
- Streamline SAS code and eliminate confusing output
HCUP statistical brief: Characteristics of Emergency Department Visits for Super-Utilizers by Payer, 2014Martina Dolan | March 2, 2017
The Healthcare Cost and Utilization Project (HCUP) has posted a new statistical brief on the following: Characteristics of Emergency Department Visits for Super-Utilizers by Payer, 2014. Emergency department (ED) super-utilizers were defined as those patients with the highest number of ED visits in 2014, by payer: four or more visits for privately insured patients aged 1–64 years or Medicare patients aged 65 years and older; six or more visits for Medicaid or Medicare patients aged 1–64 years. In 2014, although super-utilizers constituted a relatively small proportion of all patients seen in the ED (2.6 to 6.1 percent, depending on the payer-age group), they accounted for a large share of all ED visits (10.5 to 26.2 percent).
Among adults with health care expenses in 2014, those treated for multiple chronic conditions had average out-of-pocket expenses that were more than three times as high as expenses for adults with one or no chronic condition ($13,031 versus $3,579). (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #498: Out-of-Pocket Expenditures for Adults with Health Care Expenses for Multiple Chronic Conditions, U.S. Civilian Noninstitutionalized Population, 2014.)
The latest quality data refresh has been posted to CMS Nursing Home Compare. Nursing home quality data updated on CMS Nursing Home Compare as follows:
- Short-stay residents measures (9 measures) reporting data through 16Q3 except for 3 measures reporting through 15Q4
- Percentage of short-stay residents who were re-hospitalized after a nursing home admission.
- Percentage of short-stay residents who have had an outpatient emergency department visit.
- Percentage of short-stay residents who were successfully discharged to the community.
- Long-stay residents measures (15 measures) reporting data for 15Q4_16Q3
The Agency for Healthcare Research Quality (AHRQ) has announced its intention to publish a Funding Opportunity Announcement (FOA) for grant applications to stimulate innovative and collaborative research by utilizing new health information technology (IT) strategies for collecting and using patient-reported outcome (PRO) measures in primary care and other ambulatory care settings. The planned FOA is expected to be published in 2017.
PROs offer an essential perspective that complements clinician assessments, and may provide greater insights into health status, function, symptom burden, adherence, health behaviors, and quality of life. Although health IT has been shown to be an enabler of the use of PROs in certain healthcare settings with certain populations and disease types, PRO data are not commonly collected and integrated at the point of care. Electronic health record systems in use today often do not collect and present PRO data in ways that can afford truly meaningful use for broad and comprehensive clinical or health outcomes measurement and improvement. AHRQ is planning to solicit applications for projects that develop new health IT strategies for implementing existing PRO measures in ambulatory care environments, including projects that support the care of people with multiple chronic conditions. All projects must include an implementation and evaluation plan for the health IT strategy, rationale for the PRO measures selected, and how the selected PRO measures can lead to desired outcomes (e.g., patient health outcomes, quality of care).