Critical Access Hospital (CAH) PEPPER Update April, 2016 Kimberly Hrehor
Agenda Updates to the Q4FY15 CAH PEPPER release Revised target areas: Medical DRGs with CC or MCC Surgical DRGs with CC or MCC 3-day SNF-qualifying Stays Swing Bed Transfers 30-day Readmissions to Same Hospital 30-day Readmissions to Same Hospital or Elsewhere One-day Stays for Medical DRGs One-day Stays for Surgical DRGs Discontinued target areas: Syncope Medical Back Problems Same-day Stays for Medical DRGs 2
PEPPER Basics To learn the basics of PEPPER, review percents and percentiles and a review of a demonstration CAH PEPPER, please access the March 2015 recorded training sessions, which are available in the CAH Training and Resources section of PEPPERresources.org. 3
CAH PEPPER Changes, 1 Target Area Medical DRGs with CC or MCC Target Area Definition N: count of discharges for medical DRGs with a CC or MCC, excluding discharges for DRGs 065 (intracranial hemorrhage or cerebral infarction with CC or tpa in 24 hrs), 837 (chemo with acute leukemia as SDX or with high dose chemo agent with MCC), 838 (chemo with acute leukemia as SDX with CC or high dose chemo agent) D: count of discharges for medical DRGs excluding DRGs 065, 837, 838 4
CAH PEPPER Changes, 2 Target Area Surgical DRGs with CC or MCC Target Area Definition N: count of discharges for surgical DRGs with a CC or MCC, excluding discharges for DRGs 005 (liver transplant w/ MCC or intestinal implant), 023 (craniotomy w/ major device implant/acute complex CNS principal dx w/ MCC or chemo implant), 029 (spinal px w/ CC or spinal neurostimulators), 041 (peripheral/cranial nerve & other nervous system px w/ CC or peripheral neurostimulator), 129 (major head & neck px w/ CC/MCC or major device), 246 (percutaneous cardiovascular px w/ drug-eluting stent w/ MCC or 4+ vessels/stents), 248 (percutaneous cardiovascular px w/ non-drug-eluting stent w/ MCC or 4+ vessels/stents), 518 (Back & neck px except spinal fusion w/ MCC or disc/neurostimulator) D: count of all discharges for surgical DRGs excluding discharges for DRGs 005, 023, 029, 041, 129, 246, 248, 518 5
CAH PEPPER Changes, 3 Target Area Three-day SNF-qualifying Admissions Swing Bed Transfers Target Area Definition N: count of discharges to a SNF with a three-day length of stay D: count of all discharges to a SNF (identified by patient discharge status code of 03 (discharged or transferred to a SNF), 83 (discharged or transferred to a SNF with a planned acute care hospital inpatient readmission), 61 (discharged or transferred to a swing bed)) or 89 (discharged or transferred to a swing bed with a planned acute care hospital readmission)) N: count of discharges with a length of stay equal to three or four days with patient discharge status code 61 or 89 D: count of discharges with a length of stay equal to three or four days 6
CAH PEPPER Changes, 4 Target Area 30-day Readmissions to Same Hospital or Elsewhere Target Area Definition N: count of index (first) admissions for which a readmission occurred within 30 days to the same CAH, to another CAH or to another short-term acute care PPS hospital for the same beneficiary; patient discharge status of the index admission is not equal to 02 (discharged/transferred to a short-term general hospital for inpatient care), 82 (discharged/transferred to a short-term general hospital for inpatient care with a planned acute care hospital inpatient readmission), 07 (left against medical advice); excluding rehabilitation and primary psychiatric Clinical Classification Software (CCS) diagnosis categories D: count of all discharges excluding patient discharge status codes 02, 82, 07, 20 and excluding rehabilitation and primary psychiatric CCS diagnosis categories 7
CAH PEPPER Changes, 5 Target Area 30-day Readmissions to Same Hospital Target Area Definition N: count of index (first) admissions for which a readmission occurred within 30 days to the same CAH for the same beneficiary; patient discharge status of the index admission is not equal to 02, 82, 07; excluding rehabilitation and primary psychiatric CCS diagnosis categories D: count of all discharges excluding patient discharge status codes 02, 82, 07, 20 and excluding rehabilitation and primary psychiatric CCS diagnosis categories 8
CAH PEPPER Changes, 6 Target Area 1-day Stays for Medical DRGs 1-day Stays for Surgical DRGs Target Area Definition N: count of discharges for medical DRGs with a length of stay equal to one day ( through date minus admission date = 1 day, or admission date equal to through date), excluding patient discharge status codes 02, 20, 07, 82 D: count of discharges for medical DRGs N: count of discharges for surgical DRGs with a length of stay equal to one day ( through date minus admission date = 1 day, or admission date equal to through date), excluding patient discharge status codes 02, 20, 07, 82 D: count of discharges for surgical DRGs 9
CAH PEPPER Changes, 7 Discontinued three target areas: Syncope Medical Back Problems Same-day Stays for Medical DRGs 10
For assistance with PEPPER: Visit PEPPERresources.org for the PEPPER User s Guide and training materials. If you have questions or are in need of individual assistance, click on Help/Contact Us, and submit your request through the Help Desk. Complete the form and a TMF staff member will respond promptly to assist you. Please do not contact your QIO or any other organization for assistance with PEPPER. 11
Screenshot of PEPPERresources.org Program for Evaluating Payment