Comparison of
AHCA PointRight OnPoint-30 SNFRehospitalization Measure
vs
OIG SNF/NF Hospitalization Measure
Both measures are all cause rehospitalization measure but differ inwho is included in the measure, how you determine who is hospitalized and in the use of risk adjustment.
AHCA PointRight OnPoint-30SNF Rehospitalization / OIG
SNF/NF Hospitalization
Population included / All admissions to nursing home from a hospital regardless of diagnosis or payor status / OnlyMedicare Beneficiaries who had at least 1 day in the nursing home regardless if Medicare was paying for stay (both short stay and long stay individuals excluding beneficiaries enrolled in Managed Care )
- Are there age cut offs?
- Are Medicare Managed Care patients included?
- Are Commercial insurance or Medicaid onlypatients included?
- Any exclusions?
What is time window for the measure? / 12 months; / 12 months
Data Source / MDS 3.0 / Medicare Hospital Part A claims matched with MDS 3.0
Rehospitalizations counted / Allrehospitalizations for any reason to any hospital / All hospitalizations for any reason to any hospital
Hospitalizations of long stay counted / No / Yes
- Are observation stays without an inpatient admission included?
- Are planned readmissions included?
- Are Emergency Room visits without an admission included?
- What is the time frame when rehospitalizations can occur
Are the measures risk adjusted / Yes / No
- Statistical method used for risk Adjustment method
- What is the risk adjustment formula?
- What are the clinical characteristics used in the risk adjustment to calculate the expected rate?
Where can the measure results be found? / LTC Trend Tracker for individual facility measure / Only state average reported in OIG report; individual Center rates not reported
Is there a minimum sample size for reporting? / Yes; need 30 people in the denominator (e.g. admissions to a facility). / Yes, 30 people in the denominator (e.g. Medicare Beneficiaries who resided in Center for at least 1 day)
1SNF Clinical characteristics included in the OnPoint-30 risk adjustment: The OnPoint-30 risk adjustment uses logistic regression (a statistical method that can adjust for multiple clinical characteristics (e.g. age and gender) at the same time. Thirty-three different clinical variables are adjusted (see Table 1 below). The clinical variables that were found to be associated with rehospitalization in the logistic regression model were included in the statistical model. Some clinical characteristics that may be associated with an increased risk of rehospitalization are not contained in this list. This is because when combined with other characteristics in logistic regression they do not add any additional risk adjustment. For example, “continued use of oxygen” captures all the individuals with moderate to severe pulmonary diseases such as COPD, pulmonary hypertension, etc.; that by themselves are associated with increased risk of rehospitalization but when combined with the “continued use” of oxygen do not add any additional risk adjustment.
Table 1. Clinical Characteristics included in the OnPoint-30 risk adjustment
Demographic / Diagnoses- Age 65
- Anemia
- Male
- Asthma
- Medicare as Primary Payor
- Diabetes
Functional Status /
- Hx of heart failure
- Total Bowel Incontinence
- Hx of sepsis
- Easting Dependent
- Hx of viral hepatitis
- Needs 2 person Assistance in ADLs
- Hx of internal bleeding
- Cognitive impairment (Dementia)
Prognosis /
- Dialysis
- End Sate prognosis poor
- Insulin prescribed
- Recently rehospitalized
- Ostomy Care
- Hx of respiratory failure
- Cancer chemotherapy
- Receiving Hospice Care
- Receiving radiation therapy
Clinical Condition /
- Continue to receive IV medication
- Daily Pain
- Continue to receive oxygen
- Pressure Ulcer Stage (4 variables)
- Continued tracheostomy care
- Venous arterial ulcer
- Diabetic foot ulcer
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