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Hospital Visits After Hospital Outpatient Surgery

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Hospital Visits After Hospital Outpatient Surgery 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.
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