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3M PPCs apply clinical logic to review complications that occur during a hospital stay.
3M PPCs identify conditions not present on admission and determines whether the conditions were potentially preventable given patient characteristics, reason for admission, clinical procedures, and interrelationships between underlying medical conditions.
Using its clinical insights into complications, health care providers can initiate root cause analysis and focus resources on the areas with the greatest opportunity for improvement.
The 3M approach to potentially preventable complications (PPCs) takes a broad view of inpatient complications that may result from the care processes rather than natural disease progression. In California and Maryland, 3M researchers found that approximately 9 percent of inpatient hospital costs reflected PPCs such as aspiration pneumonia, cellulitis, Clostridium difficile colitis, kidney failure, encephalopathy and respiratory failure. Experience has shown that these costly complications can be reduced with concerted effort.
3M PPCs are a categorical model, which means that a PPC analysis generates a spreadsheet that shows the PPCs that occurred for patients in diagnosis-related groups. Clinicians and hospital managers can use this data to identify clinical areas where risk-adjusted PPC incidence is higher than expected.
In contrast to Medicare HACs, the 3M PPC methodology:
3M PPCs are one of the five 3M potentially preventable events (PPEs) that measure important outcomes of health care. The others are potentially preventable admissions, readmissions, emergency department visits and services. Each PPE was developed to be clinically credible, risk-adjusted for differences in patient severity, and useful to clinicians working to improve outcomes.
All about 3M PPCs
The 3M PPC methodology generates actionable insights that enable hospitals and payers to improve patient outcomes and reduce cost.
Here are a few examples of the value the 3M PPC methodology can bring to customers:
3M PPC logic is the same for every user, although different users may use different versions or choose not to report certain 3M PPCs. Each user makes its own decisions about appropriate use, including risk adjustment and comparison of individual hospital performance with an appropriate benchmark. At this time, 3M does not offer any payer-specific PPC software.
3M PPCs are integrated with other 3M patient classification methodologies.
3M PPCs are available in the following 3M products:
3M experts are available to advise hospitals, health plans, government agencies, and other interested parties on how to obtain maximum value from the use of 3M PPCs. For example, 3M consultants can help hospitals measure the incidence of potentially preventable complications, compare against benchmarks, and help design programs for improvement. 3M consultants can also help payers and other organizations measure PPCs across hospitals, design pay-for-outcomes incentive methods, and facilitate learning collaboratives to reduce PPCs and improve care.
The unit of analysis is an inpatient stay at an acute care hospital. All the data required to do a 3M PPC analysis can be obtained from a standard inpatient hospital discharge record, such as the UB-04 form or the X12N 837I electronic transaction. An individual discharge record does not need to be linked to other records or to an eligibility file. Each stay is first assigned to a 3M™ All Patient Refined DRG (APR DRG) and then examined for the presence of one or more PPCs. Data fields that are particularly important include all diagnosis codes, present on admission (POA) indicators, ICD-10-PCS procedure code, and procedure code dates. Because it is important whether or not a diagnosis was present on admission, 3M recommends that any 3M PPC analysis include an evaluation of the likely accuracy of POA indicators. Suggested criteria are available on the 3M Customer Support website.
Despite advancements in modern hospital care, quality problems remain, impacting patient outcomes and provider costs. In the early 2000s, 3M assembled a team to develop a methodology that could identify situations in which hospital care was less than excellent. The team chose not to focus on unambiguous errors (such as blood transfusion mismatches or foreign objects left in surgical patients) but instead adopted a broader perspective. The resulting methodology, 3M™ Potentially Preventable Complications (PPCs), was first published in the Health Care Financing Review in 2006. Since then, the methodology has been regularly updated and increasingly adopted across the U.S.
The 3M™ Potentially Preventable Complications (PPC) Grouping Software applies sophisticated clinical logic to identify over 60 groups of potentially preventable inpatient complications, including stroke, respiratory failure, pneumonia, venous thrombosis, liver complications, Clostridium difficile colitis, in-hospital trauma, pressure ulcers, cellulitis, acute mental health changes, and obstetric complications. Each 3M PPC is also assigned to one of eight PPC groups (e.g., perioperative complications or infectious complications) and to a PPC level of “major,” “other” or “monitor.”
The 3M PPC software identifies conditions not present on admission and determines whether they were potentially preventable given patient characteristics, reason for admission, clinical procedures and interrelationships among underlying medical conditions. The presence of a PPC typically, but not always, increases the cost of hospital care. Using all-payer data from California and Maryland, 3M researchers found that approximately nine percent of hospital inpatient cost was due to potentially preventable complications.
The 3M PPC risk adjustment methodology, with its emphasis on patient-specific severity of illness, is an alternative to the approaches taken by CMS. The Medicare and Medicaid hospital acquired conditions list has no risk adjustment at all, while the Medicare Hospital Acquired Condition Reduction Program (HACRP) includes only crude adjustment such as the number of beds or self-reported designation of intensive care units. Unlike the 3M PPC approach, HACRP scores tend to systematically penalize hospitals that treat the sickest patients, raising questions of accuracy and fairness.
Importantly, PPCs are a categorical approach to quality measurement that enables clinicians and hospital managers to drill into the results. Even if overall performance is good, opportunities for improvement usually exist. For example, a hospital’s overall performance might be “as expected” but its rate for PPC 21 (C. Diff. Colitis) might be higher than expected. This finding would lead the hospital to redouble efforts to prevent infection.
The 3M PPCs are identified through diagnosis and procedure codes listed on standard claim forms. The 3M-proprietary clinical logic is maintained by a team of 3M clinicians, data analysts, nosologists, programmers and economists and can be viewed by software licensees in an online definitions manual. 3M releases a new PPC version every October 1 to reflect updates in the ICD-10 diagnosis and procedure code sets and to include enhancements in the clinical classification logic.
Learn more about 3M PPCs
Please note that documents not published by 3M do not necessarily reflect 3M recommendations and have not been approved by 3M. These documents are listed here for the information of readers interested in the various ways that 3M patient classification methodologies have been applied. Also note that listing these references does not imply endorsement of 3M methodologies by individual authors, other organizations or government agencies.
This manual describes the Potentially Preventable Complications (PPC) classification system, a clinically-based classification system that identifies inpatient acute care hospital complications that are potentially preventable, based on computerized discharge abstract data.
This article describes the development of Potentially Preventable Complications (PPCs), a new method that uses a present on admission (POA) indicator to identify in-hospital complications among secondary diagnoses that arise after admission.
California and Maryland hospital data are used to estimate the incremental cost associated with 64 categories of hospital acquired complications.
This article describes how the State of Maryland crafted two pay-for-performance programs applicable to all hospitals and payers-a Quality-Based Reimbursement Program similar to Medicare's value-based purchasing program and a separate program that compared hospitals' risk-adjusted relative performance on a broad array of hospital-acquired conditions.
This is the final recommendation for the rate year 2020 Maryland Hospital-Acquired Conditions (MHAC) policy.
This article compares the 3M PPC approach with Medicare HACs.
This chart shows risk-adjusted rates per 10,000 discharges of Potentially Preventable Complications (PPCs) for all payer beneficiaries by hospital based on a dataset that contains Potentially Preventable Complications (PPC) observed, expected, and risk-adjusted rates for all payer beneficiaries by hospital beginning in 2009.
This study described the use of administrative data and a computer software algorithm, Potentially Preventable Complications, to support reduction of inpatient hospital complications.