Timely estimation of National Admission, readmission, and observation-stay rates in medicare patients with acute myocardial infarction, heart failure, or pneumonia using near real-time claims data

• Published in: BMC health services research Vol. 20; no. 1; p. 733
• Main Authors: Li, Shu-Xia, Wang, Yongfei, Lama, Sonam D, Schwartz, Jennifer, Herrin, Jeph, Mei, Hao, Lin, Zhenqiu, Bernheim, Susannah M, Spivack, Steven, Krumholz, Harlan M, Suter, Lisa G
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.08.2020; BioMed Central; BMC
• Subjects: Aged; Care and treatment; Codes; Datasets; Diagnosis; Disease; Forecasts and trends; Health services; Heart attack; Heart attacks; Heart failure; Heart Failure - therapy; Hospital admission and discharge; Hospitalization; Hospitals; Humans; Insurance Claim Review; Length of Stay - statistics & numerical data; Medicare; Medicare - statistics & numerical data; Medicare claims data; Myocardial Infarction - therapy; Observation; Observation stay; Patient Admission - statistics & numerical data; Patient Readmission - statistics & numerical data; Pneumonia; Pneumonia - therapy; Prediction models; Readmission; Real-time reporting; Time Factors; Trends; United States; United States; Medicare claims data; Real-time reporting; Readmission; Observation stay; Prediction models
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-020-05611-w

To estimate, prior to finalization of claims, the national monthly numbers of admissions and rates of 30-day readmissions and post-discharge observation-stays for Medicare fee-for-service beneficiaries hospitalized with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. The centers for Medicare & Medicaid Services (CMS) Integrated Data Repository, including the Medicare beneficiary enrollment database, was accessed in June 2015, February 2017, and February 2018. We evaluated patterns of delay in Medicare claims accrual, and used incomplete, non-final claims data to develop and validate models for real-time estimation of admissions, readmissions, and observation stays. These real-time reporting models accurately estimate, within 2 months from admission, the monthly numbers of admissions, 30-day readmission and observation-stay rates for patients with AMI, HF, or pneumonia. This work will allow CMS to track the impact of policy decisions in real time and enable hospitals to better monitor their performance nationally.