Hospital Visits after Urology Ambulatory Surgical Center Procedures (Version 1.0) Measure Technical Report Submitted by: Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (CORE) Prepared for: Centers for Medicare & Medicaid Services (CMS) May 2017 Table of Contents List of Tables ................................................................................................................................... 4 List of Figures .................................................................................................................................. 5 Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (CORE) Project Team ....................................................................................................................... 6 Acknowledgements ......................................................................................................................... 7 Executive Summary ................................................................................................................. 9 1.1 Rationale for Assessing Hospital Visits after Ambulatory Surgery ................................. 9 1.2 Measure Development ................................................................................................. 10 1.3 Measure Specifications ................................................................................................. 10 1.4 Distribution of Measure Scores .................................................................................... 11 1.5 Summary ....................................................................................................................... 11 Introduction .......................................................................................................................... 12 2.1 Background ................................................................................................................... 12 2.2 Definition of an Ambulatory Surgical Center (ASC) ...................................................... 12 2.3 Importance of Assessing Unplanned Hospital Visits after ASC Procedures ................. 13 2.4 Related Measures Under Development ....................................................................... 14 Measure Development Methods .......................................................................................... 15 3.1 Overview of Measure Development Process ............................................................... 15 3.2 Data Sources ................................................................................................................. 15 3.3 Cohort Definition .......................................................................................................... 16 Inclusion Criteria ..................................................................................................... 16 Exclusion Criteria..................................................................................................... 18 3.4 Outcome ....................................................................................................................... 18 Definition of Outcome ............................................................................................ 18 Outcome Timeframe ............................................................................................... 19 Multiple Qualifying Procedures within a 7-Day Period .......................................... 19 All-Cause Hospital Visits .......................................................................................... 20 Removal of Planned Admissions from the Outcome .............................................. 20 3.5 Model Development ..................................................................................................... 21 Overview ................................................................................................................. 21 Candidate Risk Factors for Patient-Level Risk Adjustment ..................................... 21 Final Risk-Adjustment Variable Selection ............................................................... 22 Model Performance and Validation ........................................................................ 23 Calculation of ASC-Level Measure Score ................................................................ 23 Hospital Visits after Urology ASC Procedures 2 ASC-Level Measure Score Reliability Testing .......................................................... 24 Disparities Testing ................................................................................................... 24 Face Validity Testing ............................................................................................... 25 Statistical Software ................................................................................................. 25 Results ................................................................................................................................... 26 4.1 Overall Summary ........................................................................................................... 26 4.2 Patient-Level Risk-Adjustment Model .......................................................................... 26 Candidate and Final Model Variables ..................................................................... 26 Model Performance and Validation ........................................................................ 27 4.3 ASC-Level Measure Score ............................................................................................. 27 ASC-Level Measure Score Variation ........................................................................ 27 ASC-Level Measure Score Reliability Testing .......................................................... 27 Disparities Testing ................................................................................................... 27 Face Validity Testing ............................................................................................... 28 Summary and Discussion ...................................................................................................... 29 References ............................................................................................................................ 30 Tables .................................................................................................................................... 33 Figures ................................................................................................................................... 44 Appendices ............................................................................................................................ 48 Appendix A: List of Included Current Procedural Terminology (CPT®) Codes Defining Urology Procedures ................................................................................................................................ 48 Appendix B: Emergency Department Visits and Observation Stays Definition ........................ 56 Appendix C: Planned Admission Algorithm .............................................................................. 57 C1. Planned Admission Algorithm Overview ........................................................................ 57 C2. Detailed Description of Readmission Algorithm Version 4.0 Adapted for Urology ASC Measure ................................................................................................................................ 57 Appendix D: Measure Score Calculation and Reporting........................................................... 74 D1. Risk-Standardized Measure Score Calculation Algorithm .............................................. 74 D2. Provider Performance Reporting.................................................................................... 74 D3. Outlier Evaluation ........................................................................................................... 75 D4. Bootstrapping Algorithm ................................................................................................ 75 Appendix E: Risk-Adjustment Model Development ................................................................. 77 Hospital Visits after Urology ASC Procedures 3 List of Tables Table 1. Frequency of risk model variables in the Medicare FFS Development and Validation Samples ................................................................................................................................. 33 Table 2. Top 20 procedures in the urology cohort (data source: Medicare FFS FY 2015 Dataset, 10/01/2014 – 09/30/2015) ................................................................................................... 33 Table 3. Number and frequency of emergency department visits, observation stays, and unplanned inpatient admissions (data source: Medicare FFS FY 2015 Dataset, 10/01/2014 – 09/30/2015) ....................................................................................................................... 35 Table 4. Top hospital visit diagnoses for any hospital visit within 7 days of urology procedures (data source: Medicare FFS FY 2015 Dataset, 10/01/2014 – 09/30/2015) .......................... 36 Table 5. Risk-adjustment model performance summaries in the Medicare Development and Validation Samples ................................................................................................................ 42 Table 6.