Post-Acute Care

Post-Acute Care

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HRR | HSA | State | County | Footnotes
(NOTE: When changing the Cohort, update the the Indicator to see the updated chart.)

Improving care coordination after discharge from the hospital is important to patients, to hospitals and to Medicare. Without high-quality care coordination, patients can bounce from home to the emergency room and back into the hospital, sometimes repeatedly. Better care coordination promises to reduce readmission rates and improve patients’ lives while reducing costs.

Post-Acute Care 2015 – by HRR

Post-Acute Care 2015 – by HSA

Post-Acute Care 2015 – by State

Post-Acute Care 2015 – by County



Denominator Definition
All medical discharges: All medical DRGs

All surgical discharges: All surgical DRGs

Acute myocardial infarction (CMS definition (excluded one-day stay): principal diagnosis code (ICD-9) 410.00, 410.01, 410.10, 410.11, 410.20, 410.21, 410.30, 410.31, 410.40, 410.41, 410.50, 410.51, 410.60, 410.61, 410.70, 410.71, 410.80, 410.81, 410.90, and 410.91

Congestive heart failure (CMS definition): principal diagnosis code (ICD-9) 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, and 428.9

Pneumonia (CMS definition): principal diagnosis code (ICD-9) 480.0, 480.1, 480.2, 480.3, 480.8, 480.9, 481, 482.0, 482.1, 482.2, 482.30, 482.31, 482.32, 482.39, 482.40, 482.41, 482.42, 482.49, 482.81, 482.82, 482.83, 482.84, 482.89, 482.9, 483.0, 483.1, 483.8, 485, 486, 487.0, and 488.11

Hip fracture (Dartmouth Atlas definition): principal diagnosis code (ICD-9) 820xx

Numerator Definition
30-Day Emergency Room Visit Rates
1) Outpatient claims: revenue center code: 0450-0459 (emergency room) and 0981 (professional fees-emergency room) and revenue center visit date not within an acute short-stay or critical access hospital claim that has emergency room payment; or 2) Hospital claims: Any acute short-stay or critical access hospital claims from the MedPAR file with emergency room payment and did not have associated Outpatient claims defined as above.

14-Day Primary Care Visit Rates
Carrier claims: CPT codes: 99201-99205, 99211-99215, 99381-99387, 99391-99397, 99241-99245, 99271-99275 and place of service = office (place of service code 11), outpatient hospital (22), rural health clinic (72) or federally qualified health center (50) and CMS specialty code 08 (family practice), 11 (internal medicine), 38 (geriatric medicine). Outpatient claims: revenue center code: 0510-0529 and provider ID from Provider of Services file as rural health center or federally qualified health center. Restricted to CMS specialties: family medicine, general internal medicine, general practice and geriatrics.

14-Day Ambulatory Visit Rates
Carrier claims: CPT codes: 99201-99205, 99211-99215, 99381-99387, 99391-99397, 99241-99245, 99271-99275 and place of service = office (place of service code 11), outpatient hospital (22), rural health clinic (72) or federally qualified health center (50) and CMS specialty code 01-08, 10-11, 13-14, 16, 18, 20, 22, 24-26, 28-30, 33-34, 36-40, 44, 46, 50, 66, 70, 76-79, 81-86, 89-94, 97-99. Outpatient claims: revenue center code: 0510-0529 and provider ID from Provider of Services file as rural health center or federally qualified health center.

Adjustments
Rates are adjusted for age, sex and race using the indirect method, using the U.S. Medicare population for each cohort as the standard.