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Identify potentially preventable readmissions using powerful clinical grouping logic.
The 3M™ Potentially Preventable Readmissions (PPR) methodology identifies inpatient readmissions that could have potentially been preventable according to clinically precise criteria. The software determines whether a readmission is clinically related to a prior admission based on the patient’s diagnosis and procedure codes associated with the prior admission and the reason for readmission.
3M PPRs were developed for use in all populations, including obstetrics and pediatrics, but they also cover all conditions. This approach stands in sharp contrast to the relatively narrow focus of the Centers for Medicare & Medicaid Services (CMS) readmission methodology.
Readmissions are only defined as potentially preventable if there is a plausible clinical connection to the initial admission. Typically, only about two-thirds of readmissions defined in all-cause analyses are considered potentially preventable in the 3M PPR methodology.
Comparisons across populations can be risk-adjusted to reflect differences in case mix across hospitals or other groupings.
3M PPRs are a categorical model, which means that analysts can generate a spreadsheet with a list of PPRs by patient, diagnosis related group (DRG) and reason. Clinicians and managers can use these data to reduce readmissions and improve care.
In 2019, 3M enhanced the 3M PPR methodology to also identify patients who return for emergency department (ED) care for a reason clinically related to an initial hospital admission, even if they are not readmitted as an inpatient. Such insight is not available from other methodologies.
All about 3M PPRs
The 3M PPR methodology generates actionable insights that enable hospitals and payers to improve patient outcomes and reduce cost.
A potentially preventable readmission (PPR) is a readmission within a specified time interval that is determined to be clinically related to a previous admission and potentially preventable. Similarly, a potentially preventable revisit to the emergency department (PPR ED) is an ED visit within a specified time window that is determined to be clinically related to an initial hospital admission and potentially preventable.
3M PPRs are most often used by payers, government agencies, hospitals, hospital systems and researchers. Users typically conduct analyses of multi-hospital data sets to compare performance on a risk-adjusted basis and identify opportunities for improvement. The same is expected of the recently released PPR ED methodology.
Here are a few examples of the value the PPR and PPR ED methodologies can bring to customers.
3M PPR and PPR ED grouping logic is the same for every user, although different organizations may use different versions. (The most recent version is recommended.) Each user makes its own decisions about appropriate uses. At this time, 3M does not offer software that replicates PPR and PPR ED reimbursement analysis used by specific payers.
3M PPRs and PPR EDs are integrated with the other 3M patient classification methodologies.
3M PPRs and PPR EDs are available in the following 3M products:
Available to licensees on the 3M Customer Support Website (covering both PPRs and PPR EDs)
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 PPRs and PPR EDs. For example, 3M consultants can help hospitals measure the incidence of potentially preventable readmissions and ED revisits, compare against benchmarks and help design programs for improvement. 3M consultants can also help payers and other organizations measure 3M PPRs and PPR EDs across hospitals, design pay-for-outcomes incentive programs and facilitate learning collaboratives to improve care.
Data requirements depend on whether the analysis is limited to inpatient readmissions or also includes revisits to the emergency department in which the patient is treated and released. A 3M PPR analysis can be done without ED data, but a PPR ED analysis requires both inpatient and ED data. In either case, all required data can be obtained from standard hospital claims, such as the UB-04 form or the X12N 837I electronic transaction. (The methodology is not designed to accept data from professional claims, such as may be submitted by urgent care clinics.) Individual records must be linked using consistent identifiers for both the patient and the hospital.
Each inpatient stay is first assigned to a 3M™ All Patient Refined Diagnosis Related Group (APR DRG). Data fields that are particularly important include admission and discharge dates, discharge status, birth date, gender, diagnosis codes with present on admission (POA) indicators, and ICD-10-PCS procedure codes. Because there are several reasons why a patient may have more than one inpatient claim within a short timeframe, we recommend that the user evaluate the reliability of the discharge status data provided by hospitals (e.g., transfers, left against medical advice, still a patient).
When the analysis also includes revisits to the emergency department, ED claims are also required. For PPR ED development, emergency department claims were defined by the combination of bill type 13X and revenue code 45X or 981. Users are responsible for selecting criteria appropriate to their own analysis. PPR ED analysis also requires the diagnosis codes that are routinely reported on outpatient hospital claims but does not require line-level detail such as procedure or revenue codes.
The challenge in readmission policy has always been to differentiate readmissions that were potentially avoidable from those that were not. In the early 2000s, 3M developed the 3M™ Potentially Preventable Readmissions (PPR) methodology. In 2007, the Medicare Payment Advisory Commission used the 3M methodology to report that 13.3 percent of Medicare inpatients had a PPR within 30 days, costing the Medicare program $12 billion in 2005. In 2008, 3M researchers published the PPR methodology in the Health Care Financing Review. This article has been cited 250 times as the 3M PPR methodology has spread across the U.S.
As with the other 3M™ Potentially Preventable Event methodologies, three core concepts are essential:
The 3M PPR methodology may be most easily understood by looking at the table above. For example, readmissions are not considered potentially preventable:
Patient 5 does have a potentially preventable readmission, because heart failure is a chronic condition that would have been present and managed in the initial admission. Results from the 3M PPR software can then be used to draw comparisons, taking into account differences in case mix across different populations. Case mix adjustment reflects not only the reason for the admission but also the severity of illness.
In 2019, 3M enhanced the PPR method by adding PPR ED logic to identify returns to the emergency department that did not result in an inpatient readmission. Previously, there was no widely available methodology to track this useful quality measure of inpatient care and of follow-up care in the community. In parallel with the 3M PPR approach, the PPR ED logic distinguishes ED visits that were and were not clinically related to an initial inpatient stay within a specified window, such as 15 or 30 days. The PPR ED logic uses diagnosis information from the ED claim to assign the visit to a 3M APR DRG, which is compared with the 3M APR DRG for the initial admission. As with 3M PPRs, supplemental logic adds precision in identifying potentially preventable revisits to the ED.
The PPR and PPR ED software shows which specific inpatient stays and ED visits were considered potentially preventable, in each case with a defined reason for the assignment. These detailed data have proven very useful to clinicians and healthcare managers in taking action to improve outcomes. For example, a common finding is that the risk of a PPR peaks at two or three days after discharge.
Further information on the 3M PPR and PPR ED logic is shown in an online definition manual available to all licensed clients.
The 3M PPR and PPR ED clinical logic is maintained by a team of 3M clinicians, data analysts, nosologists, programmers and economists. The methodology is updated annually to reflect changes in the standard diagnosis and procedure code sets as well as 3M enhancements to the clinical logic.
Learn more about 3M PPRs
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 3M Potentially Preventable Readmissions (PPR) classification system, a clinically-based classification system that identifies acute care hospital readmissions that are potentially preventable, based on the computerized discharge abstract data.
This fact sheet describes the development and use of 3M Potentially Preventable Readmissions.
3M can help you identify root causes, adjust for risk, and enhance documentation and coding to eliminate data noise and get down to seriously cutting your readmission rates.
This article examines the impact of age, payer and mental health conditions upon hospital readmissions and the comparability of same-hospital and multiple-hospital readmission rates.
The potentially preventable readmission (PPR) method uses administrative data to identify hospital readmissions that may indicate problems with quality of care.
Beginning as early as 2009, Texas began to put the antecedents in place for an effective Medicaid value-based purchasing model. Since those early activities were undertaken, Texas Medicaid is emerging as a national leader in value-based purchasing and has produced exceptional results that clearly demonstrate the value proposition associated with alignment of financial incentives.
In order to understand patterns of readmission and to identify risk factors for readmission, the Office of the Health Insurance Commissioner (OHIC) and Executive Office of Health and Human Services (EOHHS) commissioned a study to examine how many hospitalizations in 2010 were followed by another hospitalization within 15 days that was potentially preventable.
The Reducing Avoidable Readmissions Effectively (RARE) Campaign was designed to engage hospitals and care providers in Minnesota across the continuum of care to prevent avoidable hospital readmissions within 30 days of hospital discharge.
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