Kansas Care Coordination Quarterly Report October 2018 Background Communities across the Great Plains Quality Innovation Network (QIN) region are collaborating to improve care coordination and medication safety. The Great Plains QIN is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for North Dakota, South Dakota, Nebraska and Kansas. The communities across the Great Plains QIN are diverse; however, the goals of the communities are the same. The goals are to reduce avoidable hospital admissions and readmissions, including those caused by high risk medications (HRM) related to adverse drug events (ADE), improve medication safety and increase the number of nights Medicare beneficiaries stay at home. The Kansas Foundation for Medical Care (KFMC), as a partner in the Great Plains QIN, is sharing data with the communities in Kansas. Communities Communities are identified based on two factors: 1) where each ZIP code s Medicare beneficiaries received most of their care and 2) where most of a hospitals Medicare patients reside. The areas where these two factors experienced the most overlap resulted in these communities. The map below displays ZIP code level readmissions per 1,000 FFS beneficiaries for all valid ZIP codes in the state/territory. The map includes an overlay displaying all current care coordination communities. This material was prepared by the Great Plains Quality Innovation Network, the Medicare Quality Improvement Organization for Kansas, Nebraska, North Dakota and South Dakota, 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. 11SOW-GPQIN-ND-C3-46/0316 (Revised 10/18) Quarterly Report - October 2018 Page 1 of 16
Data Overview and Definitions Medicare claims data provided to the Great Plains QIN by the National Coordinating Center (NCC) was used to calculate the measures contained in this report. Readmissions are defined as "all-cause" readmissions to any hospital within 30 days of discharge. We refer to the initial hospital admission as the index discharge and the second return admission as the readmission. None of the measures are risk adjusted. -level measures included are: 30-day Hospital Readmission Rate and Trends: The percentage of hospital readmissions within 30 days of discharge Acute Care Utilization Rate: Hospital Admissions, Hospital Readmissions, Emergency Department (ED) Visits (without admission), and Observation Stays per 1000 Medicare FFS Beneficiaries Composite Measure of Unplanned Care: All Admissions, ED Visits, and Observation Stays per 1000 Medicare FFS Beneficiaries; Includes separate graphs for each acute care setting. Hospital Discharge Rate per Location: Home (), Home Health, Hospice, and Skilled Nursing Facility Hospital Readmission Rate per Discharge Location: As Above Top Five DRG Bundles for Admissions Top Five DRG Bundles for Readmissions Potential Opportunity for Improving End-of-Life Care: Hospital care utilization of Beneficiaries at End-of-Life Admissions by Drug Class: Hospital Admissions per 1000 Medicare FFS High Risk Beneficiaries; beneficiaries were identified as high risk if they take three of more medications of which at least one is from the three drug classes of Anticoagulants, Diabetic Agents, and Opioids Readmissions by Drug Class: Hospital Readmissions per 1000 Medicare FFS High Risk Beneficiaries; beneficiaries were identified as high risk if they take three or more medications of which at least one is from the three drug classes of Anticoagulants, Diabetic Agents, and Opioids Composite Measure of Unplanned Care by Drug Class: All Admissions, ED Visits, and Observation Stays per 1000 Medicare FFS High Risk Medication Beneficiaries; Includes separate graphs for each acute care setting. Timing of Readmission after Potential ADE Discharge The measures included in the Care Coordination Quarterly Report may vary from issue to issue depending on data availability and the needs of community partners. Quarterly Report - October 2018 Page 2 of 16
Data Highlights Current Readmission Rates (# of readmissions within 30 days / # of discharges): 04/01/2017 03/31/2018 Discharges Readmissions Readmission Rates Garden City 4,023 597 14.84% Hutchinson 3,672 530 14.43% Kansas City 24,955 4,460 17.87% Pittsburg 3,015 436 14.46% Topeka 12,986 2,435 18.75% Wichita 19,802 2,979 15.04% Kansas 116,060 19,072 16.43% Great Plains QIN 241,535 38,998 16.15% United States 9,795,459 1,808,415 18.46% Readmission Rate Trends: Quarterly Report - October 2018 Page 3 of 16
Acute Care Utilization (per 1,000 Beneficiaries): 04/01/2017 03/31/2018 Benes Adms Adms per 1000 Benes Readms Readms per 1000 Benes ED Visits ED Visits per 1000 Benes Obs Stays Obs Stays per 1000 Benes Garden City 15,628 4,149 265.49 597 38.20 6,870 439.60 913 58.42 Hutchinson 14,909 3,761 252.26 530 35.55 5,483 367.76 995 66.74 Kansas City 88,831 25,517 287.25 4,460 50.21 28,080 316.11 4,507 50.74 Pittsburg 12,063 3,119 258.56 436 36.14 5,782 479.32 742 61.51 Topeka 42,217 13,334 315.84 2,435 57.68 16,487 390.53 1,631 38.63 Wichita 79,559 20,421 256.68 2,979 37.44 32,810 412.40 3,107 39.05 Kansas 429,639 119,476 278.08 19,072 44.39 178,263 414.91 22,952 53.42 Great Plains QIN 949,253 249,230 262.55 38,998 41.08 349,472 368.15 51,060 53.79 United States 38,116,741 10,110,451 265.25 1,808,415 47.44 14,863,767 389.95 2,072,751 54.38 Composite Measure of Unplanned Care: Counts all the Admissions, ED visits and Observation stays per 1,000 beneficiaries. Quarterly Report - October 2018 Page 4 of 16
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Discharge Locations: 04/01/2017 03/31/2018 Discharges Home Health Home Hospice Skilled Nursing Facility All # to Home % to Home # to % to # to % to Health Health Home Home Hospice Hospice # to SNF % to SNF Garden City 4,023 196 4.9% 2,306 57.3% 68 1.7% 991 24.6% Hutchinson 3,672 366 10.0% 1,945 53.0% 162 4.4% 867 23.6% Kansas City 24,955 4,370 17.5% 12,514 50.1% 802 3.2% 5,226 20.9% Pittsburg 3,015 382 12.7% 1,543 51.2% 113 3.7% 647 21.5% Topeka 12,986 1,110 8.5% 7,267 56.0% 416 3.2% 2,218 17.1% Wichita 19,802 2,576 13.0% 10,550 53.3% 682 3.4% 4,192 21.2% Kansas 116,060 13,478 11.6% 61,603 53.1% 3,342 2.9% 26,253 22.6% Great Plains QIN 241,535 24,974 10.3% 133,560 55.3% 5,904 2.4% 56,695 23.5% Quarterly Report - October 2018 Page 6 of 16
Readmission Rates among Discharge Locations: 04/01/2017 03/31/2018 Disch Home Health Home Hospice Skilled Nursing Facility Readm Readm Rates Disch Readm Readm Rates Disch Readm Readm Rates Disch Readm Readm Rates Garden City 196 34 17.3% 2,306 320 13.9% 68 1 1.5% 991 151 15.2% Hutchinson 366 62 16.9% 1,945 271 13.9% 162 1 0.6% 867 152 17.5% Kansas City 4,370 823 18.8% 12,514 2,121 16.9% 802 15 1.9% 5,226 1,068 20.4% Pittsburg 382 68 17.8% 1,543 207 13.4% 113 3 2.7% 647 103 15.9% Topeka 1,110 266 24.0% 7,267 1,267 17.4% 416 11 2.6% 2,218 466 21.0% Wichita 2,576 533 20.7% 10,550 1,421 13.5% 682 11 1.6% 4,192 728 17.4% Kansas 13,478 2,702 20.0% 61,603 9,264 15.0% 3,342 65 1.9% 26,253 4,832 18.4% Great Plains QIN 24,974 5,074 20.3% 133,560 19,996 15.0% 5,904 101 1.7% 56,695 9,860 17.4% Quarterly Report - October 2018 Page 7 of 16
Top 5 Admission DRG Bundles: 04/01/2017 03/31/2018 DRGs that differ only in their level of complications are combined into DRG Bundles. For example, DRGs 637, 638, and 639 (Diabetes with major complications, with complications, and without complications) are combined into one DRG bundle called Diabetes. Garden City Hutchinson Kansas City Pittsburg Topeka Wichita Kansas Great Plains QIN DRG Bundle Description DRG Bundle Admissions Admissions Percent of Admissions MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 336 4,149 8.10% SEPTICEMIA OR SEVERE SEPSIS 239 4,149 5.76% SIMPLE PNEUMONIA & PLEURISY 212 4,149 5.11% HEART FAILURE & SHOCK 156 4,149 3.76% CHRONIC OBSTRUCTIVE PULMONARY DISEASE 140 4,149 3.37% SEPTICEMIA OR SEVERE SEPSIS 364 3,761 9.68% MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 342 3,761 9.09% SIMPLE PNEUMONIA & PLEURISY 163 3,761 4.33% HEART FAILURE & SHOCK 152 3,761 4.04% PSYCHOSES 130 3,761 3.46% SEPTICEMIA OR SEVERE SEPSIS 2,008 25,517 7.87% MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 1,534 25,517 6.01% HEART FAILURE & SHOCK 1,254 25,517 4.91% SIMPLE PNEUMONIA & PLEURISY 792 25,517 3.10% RENAL FAILURE 757 25,517 2.97% SEPTICEMIA OR SEVERE SEPSIS 347 3,119 11.13% MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 183 3,119 5.87% SIMPLE PNEUMONIA & PLEURISY 127 3,119 4.07% HEART FAILURE & SHOCK 114 3,119 3.66% CHRONIC OBSTRUCTIVE PULMONARY DISEASE 104 3,119 3.33% SEPTICEMIA OR SEVERE SEPSIS 1,379 13,334 10.34% MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 832 13,334 6.24% HEART FAILURE & SHOCK 635 13,334 4.76% PULMONARY EDEMA & RESPIRATORY FAILURE 527 13,334 3.95% PSYCHOSES 491 13,334 3.68% SEPTICEMIA OR SEVERE SEPSIS 2,175 20,421 10.65% MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 1,435 20,421 7.03% HEART FAILURE & SHOCK 743 20,421 3.64% PULMONARY EDEMA & RESPIRATORY FAILURE 617 20,421 3.02% RENAL FAILURE 604 20,421 2.96% SEPTICEMIA OR SEVERE SEPSIS 10,146 119,476 8.49% MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 8,049 119,476 6.74% HEART FAILURE & SHOCK 5,250 119,476 4.39% SIMPLE PNEUMONIA & PLEURISY 5,117 119,476 4.28% PSYCHOSES 3,452 119,476 2.89% SEPTICEMIA OR SEVERE SEPSIS 19,619 249,230 7.87% MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY 18,284 249,230 7.34% HEART FAILURE & SHOCK 11,055 249,230 4.44% SIMPLE PNEUMONIA & PLEURISY 10,995 249,230 4.41% CHRONIC OBSTRUCTIVE PULMONARY DISEASE 7,230 249,230 2.90% Quarterly Report - October 2018 Page 8 of 16
Top 5 Readmission DRG Bundles: 04/01/2017 03/31/2018 Garden City Hutchinson Kansas City Pittsburg Topeka Wichita Kansas Great Plains QIN DRG Bundle Description DRG Bundle Readmissions Readmissions Percent of Readmissions SEPTICEMIA OR SEVERE SEPSIS 39 597 6.53% HEART FAILURE & SHOCK 34 597 5.70% ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS 27 597 4.52% SIMPLE PNEUMONIA & PLEURISY 25 597 4.19% KIDNEY & URINARY TRACT INFECTIONS 19 597 3.18% SEPTICEMIA OR SEVERE SEPSIS 41 530 7.74% HEART FAILURE & SHOCK 34 530 6.42% PSYCHOSES 31 530 5.85% CHRONIC OBSTRUCTIVE PULMONARY DISEASE 20 530 3.77% SIMPLE PNEUMONIA & PLEURISY 20 530 3.77% SEPTICEMIA OR SEVERE SEPSIS 368 4,460 8.25% HEART FAILURE & SHOCK 293 4,460 6.57% RENAL FAILURE 176 4,460 3.95% ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS 150 4,460 3.36% CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS 126 4,460 2.83% SEPTICEMIA OR SEVERE SEPSIS 58 436 13.30% CHRONIC OBSTRUCTIVE PULMONARY DISEASE 23 436 5.28% PSYCHOSES 19 436 4.36% SIMPLE PNEUMONIA & PLEURISY 19 436 4.36% HEART FAILURE & SHOCK 17 436 3.90% RENAL FAILURE 17 436 3.90% SEPTICEMIA OR SEVERE SEPSIS 251 2,435 10.31% HEART FAILURE & SHOCK 154 2,435 6.32% PULMONARY EDEMA & RESPIRATORY FAILURE 115 2,435 4.72% PSYCHOSES 101 2,435 4.15% CHRONIC OBSTRUCTIVE PULMONARY DISEASE 78 2,435 3.20% SEPTICEMIA OR SEVERE SEPSIS 347 2,979 11.65% HEART FAILURE & SHOCK 156 2,979 5.24% RENAL FAILURE 110 2,979 3.69% PSYCHOSES 103 2,979 3.46% PULMONARY EDEMA & RESPIRATORY FAILURE 90 2,979 3.02% SEPTICEMIA OR SEVERE SEPSIS 1,653 19,072 8.67% HEART FAILURE & SHOCK 1,188 19,072 6.23% SIMPLE PNEUMONIA & PLEURISY 715 19,072 3.75% PSYCHOSES 639 19,072 3.35% RENAL FAILURE 612 19,072 3.21% SEPTICEMIA OR SEVERE SEPSIS 3,113 38,998 7.98% HEART FAILURE & SHOCK 2,401 38,998 6.16% SIMPLE PNEUMONIA & PLEURISY 1,528 38,998 3.92% PSYCHOSES 1,514 38,998 3.88% CHRONIC OBSTRUCTIVE PULMONARY DISEASE 1,302 38,998 3.34% Quarterly Report - October 2018 Page 9 of 16
Potential Opportunity for Improving End-of-Life Care: 04/01/2017 03/31/2018 This is a proxy measure to identify opportunities for discussing an individual s preferences for end-of-life care, including where he or she would like to receive that care. Deceased Bene Total # of Deceased Benes With at Least One 30- Day Readmission in Last Six Months of Life % of Deceased Benes With at Least One 30- Day Readmission in Last Six Months of Life # of Deceased Benes Who Died While Hospital Inpatient % of Deceased Benes Who Died While Hospital Inpatient Garden City 645 78 12.09% 107 16.59% Hutchinson 741 92 12.42% 81 10.93% Kansas City 4,545 528 11.62% 473 10.41% Pittsburg 586 63 10.75% 88 15.02% Topeka 1,963 291 14.82% 309 15.74% Wichita 3,988 423 10.61% 527 13.21% Kansas 20,767 2,581 12.43% 2,909 14.01% Great Plains QIN 45,401 5,393 11.88% 6,527 14.38% Quarterly Report - October 2018 Page 10 of 16
Admissions by High Risk Drug Class: Counts the admissions per 1,000 FFS high risk medication (HRM) beneficiaries by anticoagulant, diabetic agent, and opioid drug classes and compares to overall admission rates for all Medicare FFS beneficiaries (including those with and without HRMs). Readmissions by High Risk Drug Class: Counts the 30-day readmissions per 1,000 FFS high risk medication (HRM) beneficiaries by anticoagulant, diabetic agent, and opioid drug classes and compares to overall 30-day readmission rates for all Medicare FFS beneficiaries (including those with and without HRMs). Quarterly Report - October 2018 Page 11 of 16
Composite Measure of Unplanned Care by Drug Class: Counts all the Admissions, ED visits and Observation stays per 1,000 HRM beneficiaries by anticoagulant, diabetic agent, and opioid drug classes and compares to overall rates for all Medicare FFS beneficiaries (including those with and without HRMs). Quarterly Report - October 2018 Page 12 of 16
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How many days after being discharged with a potential ADE were Medicare Beneficiaries readmitted: 04/01/2017 03/31/2018 Quarterly Report - October 2018 Page 14 of 16
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For any questions on this report, please contact Beth Nech at 785.271.4120 or bnech@kfmc.org. Quarterly Report - October 2018 Page 16 of 16