medicare fee-for-service (ffs) hospital utilization report · 3/29/2019 · report details - this...

Medicare Fee-For-Service (FFS) Hospital Utilization Report

Maryland Statewide Data

Report Date: 3/29/2019

Report Timeframe: Q4-2017 to Q3-2018

This material was prepared by Health Quality Innovators (HQI), the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for

Maryland and Virginia, with support from Telligen, the QIN National Coordinating Center, under contract with the Centers for Medicare & Medicaid Services

(CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HQI|11SOW|20190329-

135829

Group/Measure Description

National/USAll Medicare fee-for-service (FFS) beneficiaries residing in any valid ZIP code in the 50 States, District of Columbia, Puerto Rico,

the United States (US) Virgin Islands, and outer Pacific islands.

State All Medicare FFS beneficiaries residing in any valid ZIP code in the state/territory.

Eligible Beneficiaries Number of Medicare FFS beneficiaries who reside in the ZIP codes associated with the designated grouping.

AdmissionsNumber of hospitalizations from short-term hospitals, critical access hospitals (CAHs), psychiatric hospitals, and psychiatric

units among eligible Medicare FFS beneficiaries who reside in the ZIP codes associated with the designated grouping.

Readmissions

Number of readmissions within 30 days of a hospital discharge among eligible Medicare FFS beneficiaries residing in the ZIP

codes associated with the designated grouping. Readmissions and hospital discharges are from short-term hospitals, CAHs,

psychiatric hospitals, and psychiatric units.

Emergency Department VisitsNumber of ED visits from short-term hospitals, CAHs, psychiatric hospitals, and psychiatric units among eligible FFS

beneficiaries residing in the ZIP codes associated with the designated grouping.

Observation StaysNumber of observation stays from short-term hospitals, CAHs, psychiatric hospitals, and psychiatric units among eligible FFS

beneficiaries residing in the ZIP codes associated with the designated grouping.

• Frequency of days until readmission broken down by return to same hospital versus other hospital

Supplemental Information on Groups and Measures

Report Details - This report contains the following data:

Summary data for yearlong timeframe (Q4-2017 through Q3-2018)

• Hospital utilization raw numbers and per 1,000 beneficiaries rates for admissions, readmissions, emergency department visits, and

observation stays comparing state to nation

• 30-day readmission rates by beneficiary demographics (gender, race/ethnicity, age group)

• 30-day readmission rates by length of stay and primary discharge destination

• Percentages of institutional days by setting, of vaccination rates, and home health services utilized

Data sources: Medicare Part A claims and QIN NCC Scorecard [Data pulled January 2019]

• Top 10 principal discharge diagnoses leading to a 30-day readmission by discharge destination

Quarterly data for three-years of time (Q4-2017 through Q3-2018)

• Rates per 1,000 beneficiaries for admissions, readmissions, emergency department visits, and observation stays comparing state

to nation, and % of live discharges readmitted within 30 days comparing state to nation

• Percent of live discharges readmitted within 30 days by primary discharge destination

• Hospital utilization (includes admissions, emergency department visits, and observation stays) and readmissions per 1,000 high-risk

medication (HRM) beneficiaries on opioids, anticoagulants, or diabetics.

• Readmission rates by discharge destination and age distribution of beneficiaries with diabetes

• Percent of live discharges readmitted within 30 days for beneficiaries with diabetes

RAW DATA Maryland Nation Maryland Nation

# Eligible Beneficiaries 881,565 38,095,369 244.53 261.89

# Admissions 216,160 10,004,195 42.87 46.99

# Readmissions 37,899 1,794,983 334.85 383.12

# Discharges 208,982 9,694,493 70.16 54.33

# ED Visits 296,003 14,635,153 18.14% 18.52%

# Observations Stays 62,021 2,075,218

Table 2. Maryland vs. Nation Hospital Utilization Rates

Maryland Statewide Overview

(Q4-2017 to Q3-2018)

% of Live Discharges Readmitted Within 30 Days

# Observation Stays per 1,000 Beneficiaries

# ED Visits per 1,000 Beneficiaries

# Readmissions per 1,000 Beneficiaries

# Admissions per 1,000 Beneficiaries

RATES

Table 1: Maryland vs. Nation Raw Hospital Utilization Data


(Q4-2017 to Q3-2018)

Table w/ PPV w/ flu vaccine using HHA

# eligible benes 614653 644652 881,565

# benes with X 351246 385643 179780

% with Pneumococcal Vaccination (Q4-2017 to Q3-2018)57.15%

% with Flu Vaccination (Aug2017-Mar2018)59.82%

% using HHA (Q4-2017 to Q3-2018) 20.39%

LTACHs 13,675

Rehab Units & Hospitals 43,321

Psych Units & Hospitals 49,092

Short-Term Hospital 1,411,263

SNFs & Swing Beds 2,630,684

244.53

42.87

334.85

70.16

18.14%

261.89

46.99

383.12

54.3318.52%

0.00

100.00

200.00

300.00

400.00

500.00

# Admissions per 1,000

Beneficiaries

# Readmissions per 1,000

Beneficiaries

# ED Visits per 1,000

Beneficiaries

# Observation Stays per

1,000 Beneficiaries

% of Live Discharges

Readmitted Within 30 Days

Statewide vs. National Hospital Utilization Rates (Q4-2017 to Q3-2018)

Maryland Nation

57.15%59.82%

20.39%

0%

10%

20%

30%

40%

50%

60%

70%

% with Pneumococcal

Vaccination (Q4-2017 to

Q3-2018)

% with Flu Vaccination

(Aug2017-Mar2018)

% using HHA (Q4-2017 to

Q3-2018)

% of Eligible Medicare Beneficiaries Receiving

Vaccinations and Using Home Health Services

LTACHs

0%

Rehab Units

& Hospitals

1% Psych Units

& Hospitals

1%

Short-Term

Hospital

34%

SNFs &

Swing Beds

64%

% of Medicare Institutional Days Spent by Setting

(Q4-2017 to Q3-2018)

BENEFICIARY SEX &

RACE/ETHNICITYDischarges Readmissions Readm30%

BENEFICIARY

AGE GROUPDischarges Readmissions Readm30%

Males 93,589 17,877 19.10% Under 65 39,382 9,235 23.45%

Females 112,756 18,997 16.85% 65-69 32,218 5,405 16.78%

White 134,798 22,476 16.67% 70-74 35,278 5,819 16.49%

Black 61,238 12,657 20.67% 75-79 32,153 5,697 17.72%

Asian 3,172 548 17.28% 80-84 27,017 4,489 16.62%

Hispanic 1,853 336 18.13% 85 and Older 40,298 6,229 15.46%


(Q4-2017 to Q3-2018)

Table 3. Maryland % of Live Discharges Readmitted Within 30 Days by Demographics (Beneficiary Sex, Race/Ethnicity, and Age Group)

19.1%16.8% 16.7%

20.7%17.3% 18.1%

0%

10%

20%

30%

0

50,000

100,000

150,000

Males Females White Black Asian Hispanic

Maryland 30-Day Readmission % by Beneficiary Sex and

Race/Ethnicity

Discharges Readmissions Readm30% 23.4%

16.8% 16.5% 17.7% 16.6% 15.5%

0%

5%

10%

15%

20%

25%

0

10,000

20,000

30,000

40,000

50,000

Under 65 65-69 70-74 75-79 80-84 85 and

Older

Maryland 30-Day Readmission % by Beneficiary Age Group

Discharges Readmissions Readm30%

0

500

1000

1500

2000

2500

3000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

Histogram of Days Until Readmission by Day and Readmit Location

Readmitted to Same Hospital Readmitted to Other Hospital


(Q4-2017 to Q3-2018)

Length of Stay Discharges Readmissions Readm30%

1 - 3 days 94,920 13,724 14.46%

4 - 7 days 72,155 13,629 18.89% HHA 39,494 7,616 19.28%

8 - 14 days 29,313 6,828 23.29% Home 99,302 16,498 16.61%

15 - 21 days 6,743 1,653 24.51% SNF 45,683 8,861 19.40%

> 21 days 3,845 1,040 27.05% Hospice 7,147 171 2.39%

ICD-10 Code HHA Home SNF Other Total

A41.9 447 638 828 240 2,153

I13.0 400 652 319 125 1,496

J44.1 194 597 143 69 1,003

I11.0 209 470 155 86 920

N17.9 196 349 254 60 859

J18.9 180 335 179 54 748

I21.4 118 244 106 141 609

N39.0 131 199 203 45 578

J96.01 108 174 121 65 468

J96.21 131 161 119 37 448

Discharge

DestinationReadm30%ReadmissionsDischarges

Table 4. Maryland % of Live Discharges Readmitted Within

30 Days by Length of Stay

Table 5. Maryland % of Live Discharges Readmitted Within

30 Days by Primary Discharge Destination

Acute and chronic respiratory failure with hypoxia

Principal Discharge Diagnosis

Sepsis, unspecified organism

Chronic obstructive pulmonary disease, acute exacerbation

Pneumonia, unspecified organism

Acute respiratory failure with hypoxia

Hypertensive heart and chronic kidney disease with heart failure and stage 1-4 or unspecified CKD

Acute kidney failure, unspecified

Urinary tract infection, site not specified

Hypertensive heart disease with heart failure

Non-ST elevation (NSTEMI) myocardial infarction

14.5%18.9%

23.3% 24.5%27.0%

0%

10%

20%

30%

0

50,000

100,000

1 - 3 days 4 - 7 days 8 - 14 days 15 - 21 days > 21 days

Maryland Readmission % by Length of Stay


19.3%16.6%

19.4%

2.4%

0%

10%

20%

30%

0

50,000

100,000

150,000

HHA Home SNF Hospice

Maryland Readmission % by Discharge Destination


447

400

194

209

196

180

118

131

108

131

638

652

597

470

349

335

244

199

174

161

828

319

143

155

254

179

106

203

121

119

0 500 1,000 1,500 2,000 2,500

Sepsis, unspecified organism

Hypertensive heart and chronic kidney disease with heart failure and stage…

Chronic obstructive pulmonary disease, acute exacerbation

Hypertensive heart disease with heart failure

Acute kidney failure, unspecified

Pneumonia, unspecified organism

Non-ST elevation (NSTEMI) myocardial infarction

Urinary tract infection, site not specified

Acute respiratory failure with hypoxia

Acute and chronic respiratory failure with hypoxia

Top 10 Principal Discharge Diagnoses Leading to a 30-Day Readmission by Discharge Destination

(Q4-2017 to Q3-2018)

HHA Home SNF Other

Readmissions per 1,000

HRM Beneficiaries

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017CY 2017

4/2017-

3/2018

7/2017-

6/2018

Hospital Utilization per

1,000 HRM Beneficiaries

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017CY 2017

4/2017-

3/2018

7/2017-

6/2018

Opioids 167.24 164.26 163.96 160.90 161.28 163.12 Opioids 1888.04 1874.70 1867.92 1869.32 1862.59 1855.45


(Q1-2017 to Q2-2018)

167.24

164.26 163.96

160.90 161.28

163.12

156

158

160

162

164

166

168

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017

CY 2017 4/2017-

3/2018

7/2017-

6/2018

Readmissions per 1,000 High-Risk Medication

Beneficiaries on Opioids

1888.04

1874.701867.92 1869.32

1862.591855.45

18301840185018601870188018901900

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017

CY 2017 4/2017-

3/2018

7/2017-

6/2018

Hospital Utilization per 1,000 High-Risk Medication

Beneficiaries on Opioids


(Q1-2017 to Q2-2018)


HRM Beneficiaries

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017CY 2017

4/2017-

3/2018

7/2017-

6/2018



4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017CY 2017

4/2017-

3/2018

7/2017-

6/2018

Anticoagulants 186.90 181.14 177.98 172.11 169.75 172.72 Anticoagulants 1676.95 1662.19 1665.35 1667.24 1651.98 1651.39

186.90

181.14177.98

172.11169.75

172.72

160

165

170

175

180

185

190

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017

CY 2017 4/2017-

3/2018

7/2017-

6/2018


Beneficiaries on Anticoagulants1676.95

1662.191665.35 1667.24

1651.98 1651.39

1630

1640

1650

1660

1670

1680

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017

CY 2017 4/2017-

3/2018

7/2017-

6/2018


Beneficiaries on Anticoagulants


(Q1-2017 to Q2-2018)


HRM Beneficiaries

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017CY 2017

4/2017-

3/2018

7/2017-

6/2018



4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017CY 2017

4/2017-

3/2018

7/2017-

6/2018

Diabetics 93.88 90.94 90.11 87.07 85.27 86.99 Diabetics 1097.82 1089.60 1087.36 1081.02 1068.20 1071.87

93.88

90.94 90.11

87.0785.27

86.99

80

85

90

95

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017

CY 2017 4/2017-

3/2018

7/2017-

6/2018


Beneficiaries on Diabetics

1097.821089.60 1087.36

1081.02

1068.201071.87

1050

1060

1070

1080

1090

1100

1110

4/2016 -

3/2017

7/2016 -

6/2017

10/2016 -

9/2017

CY 2017 4/2017-

3/2018

7/2017-

6/2018


Beneficiaries on Diabetics

Table 6: REGION Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018

Diabetes 20.51% 20.97% 20.56% 20.73% 20.69% 20.43% 20.19% 20.63% 20.47% 20.51% 20.75% 19.82%No Diabetes 16.57% 16.32% 15.99% 16.43% 16.25% 16.09% 15.51% 15.62% 15.99% 16.19% 16.07% 15.60%

MD Discharges Readm30 Readm30% MD Count

HHA 16,560 3,580 21.6% 21-25 24

Home 38,023 6,991 18.4% 26-30 75

SNF 20,091 4,575 22.8% 31-35 142

Hospice 2,437 72 3.0% 36-40 289

Other 6,239 1,781 28.5% 41-45 230

46-50 469

51-55 764

56-60 1,150

61-65 1,651

66-70 3,043

71-75 2,893

76-80 2,665

81-85 1,858

86-90 1,178

91-95 466

96-100 88

101-105 14

Maryland Statewide Quarterly Data

(Q4-2015 to Q3-2018)

% of Live Discharges Readmitted Within 30 Days for Beneficiaries with Diabetes

20.51%20.97% 20.56% 20.73% 20.69% 20.43% 20.19%

20.63% 20.47% 20.51% 20.75%19.82%

16.57% 16.32% 15.99%16.43% 16.25% 16.09%

15.51% 15.62% 15.99% 16.19% 16.07%15.60%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%

22.00%

Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018

% of Live Discharges Readmitted Within 30 Days for Beneficiaries with Diabetes

Diabetes No Diabetes

21.6%

18.4%

22.8%

3.0%

28.5%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

HHA Home SNF Hospice Other

Maryland 30-Day Readmission % for Beneficiaries with

Diabetes

Discharges Readm30 Readm30%

0

500

1,000

1,500

2,000

2,500

3,000

3,500

21-2

5

26-3

0

31-3

5

36-4

0

41-4

5

46-5

0

51-5

5

56-6

0

61-6

5

66-7

0

71-7

5

76-8

0

81-8

5

86-9

0

91-9

5

96-1

00

101-1

05

Age Distribution of Maryland Statewide Beneficiaries with

Diabetes Readmitting Within 30 Days


Maryland 66.02 67.39 66.34 63.73 64.66 68.72 63.61 60.49 61.48 65.37 61.02 57.39Nation 67.07 69.50 67.55 65.57 66.43 71.18 67.07 64.57 65.92 69.70 64.98 62.04

Table 8:

REGION Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018

Maryland 11.87 12.09 11.74 11.52 11.56 12.07 10.98 10.58 10.82 11.49 10.86 9.84Nation 12.01 12.44 12.06 11.91 11.93 12.77 12.08 11.73 11.91 12.46 11.65 11.10


(Q4-2015 to Q3-2018)

Admissions per 1,000 Beneficiaries

30-Day Readmissions per 1,000 Beneficiaries

66.0267.39 66.34

63.73 64.66

68.72

63.61

60.49 61.48

65.37

61.02

57.39

50.00

55.00

60.00

65.00

70.00

75.00

Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018

Admissions per 1,000 Beneficiaries

Nation Maryland

11.87 12.0911.74 11.52 11.56

12.07

10.9810.58 10.82

11.4910.86

9.84

8.00

9.00

10.00

11.00

12.00

13.00

14.00

Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018

30-Day Readmissions per 1,000 Beneficiaries

Nation Maryland


(Q4-2015 to Q3-2018)

Table 9:


Maryland 86.19 81.78 86.43 88.30 83.95 84.22 87.07 87.71 83.18 82.73 84.68 85.17Nation 97.56 97.02 100.55 102.08 97.51 98.59 99.63 100.92 96.97 96.01 95.65 95.54

Table 10:


Maryland 16.49 16.62 16.85 16.85 16.88 17.38 17.41 17.27 17.53 17.38 18.03 17.41Nation 13.77 14.08 14.35 14.15 13.86 14.11 13.96 13.89 13.69 13.60 13.77 13.42

Observation Stays per 1,000 Beneficiaries

Emergency Department Visits per 1,000 Beneficiaries

86.1981.78

86.43 88.3083.95 84.22

87.07 87.7183.18 82.73 84.68 85.17

60.00

70.00

80.00

90.00

100.00

110.00

Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018

Emergency Department Visits per 1,000 Beneficiaries

Nation Maryland

16.49 16.62 16.85 16.85 16.88 17.38 17.41 17.27 17.53 17.3818.03

17.41

8.00

10.00

12.00

14.00

16.00

18.00

20.00

Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018

Observation Stays per 1,000 Beneficiaries

Nation Maryland


(Q4-2015 to Q3-2018)


Maryland 18.56% 18.58% 18.27% 18.66% 18.53% 18.20% 17.82% 18.06% 18.22% 18.24% 18.34% 17.71%

Nation 18.50% 18.53% 18.40% 18.71% 18.56% 18.55% 18.56% 18.71% 18.66% 18.52% 18.46% 18.41%

Table 12:

SETTING Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018

HHA 19.96% 18.97% 19.20% 19.90% 20.31% 19.42% 19.12% 19.81% 19.13% 19.18% 19.68% 19.14%

Home 17.20% 17.46% 16.96% 17.37% 17.09% 16.72% 16.47% 16.19% 16.77% 16.50% 16.71% 16.48%

SNF 19.98% 19.86% 19.83% 19.68% 19.29% 19.56% 19.35% 19.40% 19.26% 19.94% 19.65% 18.64%

Hospice 2.87% 2.32% 2.20% 2.98% 2.83% 2.33% 2.27% 2.43% 2.79% 2.13% 2.58% 2.06%

Maryland % of Live Discharges Readmitted by Primary Discharge Destination


18.56% 18.58%18.27%

18.66% 18.53%18.20%

17.82%18.06% 18.22% 18.24% 18.34%

17.71%

15.00%

16.00%

17.00%

18.00%

19.00%

Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018


Nation Maryland

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Q4-2015 Q1-2016 Q2-2016 Q3-2016 Q4-2016 Q1-2017 Q2-2017 Q3-2017 Q4-2017 Q1-2018 Q2-2018 Q3-2018

Maryland % of Live Discharges Readmitted Within 30 Days by Primary Discharge Destination

HHA Home SNF Hospice

Contact Name Position/Description Email Address Telephone #

HQI Main Office (804)289-5320

Carla Thomas Director, Care Transitions [email protected] (804)289-5318

Kelly Arthur Improvement Consultant, Care Transitions [email protected] (804)289-5344

Jennifer Igo Improvement Consultant, Care Transitions [email protected] (804)289-5333

About HQI

As the QIN-QIO for Maryland and Virginia, HQI convenes patients, providers and stakeholders to rapidly improve health quality and achieve better health,

better care and lower costs. We do this work through CMS’ QIO Program, the cornerstone of Medicare’s efforts to improve the quality and value of health

care for its more than 45 million beneficiaries. For additional information on this report or our organization, please see contact table below:

mailto:[email protected]



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