Incorporating Present-on-Admission Indicators in Medicare Claims to Inform Hospital Quality Measure Risk Adjustment...

Area of Science:

• Health Services Research
• Health Informatics
• Quality Improvement

Background:

• Present-on-admission (POA) indicators distinguish preexisting conditions from hospital-acquired ones in administrative claims.
• Their impact on claims-based hospital quality measures and risk factor understanding in ICD-10 settings is not well-established.

Purpose of the Study:

• To evaluate the use of POA indicators on Medicare claims.
• To assess their impact on hospital and patient outcomes for risk factor identification in CMS quality measures.

Main Methods:

• Comparative effectiveness study using national Medicare claims data (July 2015-June 2018).
• Six hospital quality measures (readmission, mortality) were modified with POA indicators for risk adjustment.
• Compared POA-inclusive models with existing complications-of-care algorithms.
• Included Medicare and VA beneficiaries aged 65+ with specific inpatient conditions.

Main Results:

• POA indicators improved risk adjustment model performance, especially for mortality measures.
• Example: C statistic for acute myocardial infarction mortality increased from 0.728 to 0.774.
• Demonstrated improvements in patient-level and hospital-level performance metrics.

Conclusions:

• Leveraging POA indicators enhances risk adjustment, better capturing patient risk factors and improving model performance.
• Incorporating POA indicators is easily implementable for public quality reporting without extra hospital burden.