Hospital Visits after Hospital Outpatient Surgery
NQF Endorsement Status Endorsed
NQF ID 2687
Measure Type Outcome
Measure Content Last Updated 2021-06-30
Info As Of Not Available
Properties
Description Facility-level, post-surgical risk-standardized hospital visit ratio (RSHVR) of the predicted to expected number of all-cause, unplanned hospital visits within 7 days of a same-day surgery at a hospital outpatient department (HOPD) among Medicare fee-for-service (FFS) patients aged 65 years and older.
Numerator The outcome is all-cause, unplanned hospital visits, defined as 1) an inpatient admission directly following surgery or 2) an emergency department [ED] visit, observation stay, or unplanned inpatient admission occurring after discharge from the HOPD and within 7 days of the outpatient surgery.
Denominator Eligible same-day surgeries or cystoscopy procedures with intervention performed at HOPDs for Medicare FFS patients aged 65 years and older with the exception of eye surgeries and same day surgeries performed concurrently with high-risk procedures.
Denominator Exclusions "The measure excludes: - Surgeries for patients without continuous enrollment in Medicare FFS Parts A and B in the 7 days after the surgery. - Surgeries for patients who have an ED visit on the same day but billed on a separate claim, unless the ED visit has a diagnosis indicative of a complication of care; - Surgeries that are billed on the same hospital claim as an ED visit and that occur on the same calendar day, unless the ED visit has a diagnosis indicative of a complication of care - Surgeries that are billed on the same hospital outpatient claim and that occur after the ED visit - Surgeries that are billed on the same outpatient claim as an observation stay"
Report Generated: Sat Oct 02 12:17:34 EDT 2021 | Page 1
Hospital Visits after Hospital Outpatient Surgery
Rationale "Outpatient same-day surgery is exceedingly common in the United States. Nearly 70% of all surgeries in the US are now performed in the outpatient setting with most performed as same-day surgeries at HOPDs [1]. While most outpatient surgery is safe, there are well-described and potentially preventable adverse events that occur after outpatient surgery, which can result in unanticipated hospital visits. Unanticipated hospital visits following same-day surgery reflect quality of care. Similarly, direct admissions after surgery that are primarily caused by non-clinical patient considerations, such as lack of transport home upon discharge, or facility logistical issues, such as delayed start of surgery, are common causes of unanticipated yet preventable hospital admissions following same-day surgery. A quality measure of hospital visits following outpatient same-day surgery can improve transparency, inform patients and providers, and foster quality improvement. [1]Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. National health statistics reports. Jan 28 2009(11):1-25. "
Evidence Not Available
Developer/Steward
Steward Centers for Medicare & Medicaid Services (CMS)
Contact Not Available
Measure Developer Yale New Haven Health Services Corporation
Development Stage Fully Developed
Characteristics
Measure Type Outcome
Meaningful Measure Area Admissions and Readmissions to Hospitals
Report Generated: Sat Oct 02 12:17:34 EDT 2021 | Page 2
Hospital Visits after Hospital Outpatient Surgery
Healthcare Priority Promote Effective Communication & Coordination of Care eCQM Spec Available No
NQF Endorsement Status Endorsed
NQF ID 2687
Last NQF Update 2020-11-20
Target Population Age 65+
Target Population Age (High) Not Available
Target Population Age (Low) 65
Reporting Level Facility
Conditions Not Available
Subconditions Not Available
Care Settings Hospital : Acute Care Facility; Hospital Outpatient; Hospital Outpatient Surgery Department/Ambulatory Surgery Center; Hospital/Acute Care Facility
Groups
Core Measure Set Not Available
Measure Group Group Identifier
OP 36
Measure Links
Measure Program: Hospital Outpatient Quality Reporting
Report Generated: Sat Oct 02 12:17:34 EDT 2021 | Page 3
Hospital Visits after Hospital Outpatient Surgery
Info As Of Not Available
Program / Model Notes
Data Sources Not Available
Purposes Not Available
Quality Domain Promote Effective Communication & Coordination of Care
Reporting Frequency Not Available
Impacts Payment No
Reporting Status Active
Data Reporting Begin Date 2020-01-01
Data Reporting End Date Not Available
Measure Program Links https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment- Instruments/HospitalQualityInits/HospitalOutpatientQualityReportingProgram
Milestones
Milestone: Implemented
Effective Date 2020-01-01
Comments Not Available
Milestone Links https://www.federalregister.gov/documents/2016/11/14/2016-26515/medicare- program-hospital-outpatient-prospective-payment-and-ambulatory-surgical- center-payment
Milestone: Finalized
Effective Date 2016-11-14
Report Generated: Sat Oct 02 12:17:34 EDT 2021 | Page 4
Hospital Visits after Hospital Outpatient Surgery
Comments Not Available
Milestone Links https://www.federalregister.gov/documents/2017/12/14/R1-2017- 23932/medicare-program-hospital-outpatient-prospective-payment-and- ambulatory-surgical-center-payment
https://www.federalregister.gov/documents/2016/11/14/2016-26515/medicare- program-hospital-outpatient-prospective-payment-and-ambulatory-surgical- center-payment
Milestone: Proposed
Effective Date 2016-07-14
Comments Not Available
Milestone Links https://www.federalregister.gov/articles/2016/07/14/2016-16098/medicare- program-hospital-outpatient-prospective-payment-and-ambulatory-surgical- center-payment#h-252
Milestone: Reference
Effective Date 1900-01-01
Comments Not Available
Milestone Links https://www.federalregister.gov/documents/2016/11/14/2016-26515/medicare- program-hospital-outpatient-prospective-payment-and-ambulatory-surgical- center-payment
Report Generated: Sat Oct 02 12:17:34 EDT 2021 | Page 5