Solventum™ Potentially Preventable Complications (PPCs) Classification System

Solventum PPCs define harmful events (like an accidental laceration during a procedure) or negative outcomes (such as hospital-acquired pneumonia) that may resultfrom the process of care rather than the natural progression of a disease.

Solventum PPCs are used by hospitals, payers, government agencies and researchers. A hospital can use the Solventum PPC methodology on its own; for example, a hospital can calculate its own PPC rates in a base year and then work to improve future performance. Hospital, payers, government agencies and researchers typically undertake analyses of multi-hospital data sets in order to compare performance and identify opportunities for improvement.

Here are a few examples of the value the Solventum PPC methodology can bring to customers:

• Improving quality. Through concerted effort, Maryland hospitals reduced the statewide PPC count by 68 percent between 2010 and 2015, from 53,494 to 17,028. The Maryland Health Services Cost Review Commission used the Solventum methodology to measure the incidence of potentially preventable complications, compare hospitals on a risk-adjusted basis, and provide the data back to the hospitals to take action. (Note: Maryland uses the term “Maryland Hospital Acquired Conditions” to refer to Solventum PPC.)
  
  
• Public reporting. The New York Department of Health reports risk-adjusted PPC rates for each hospital on its website.
  
  
• Enabling insight. In one Medicaid program, four percent of inpatients experienced at least one potentially preventable complication; however, rates varied by category. For example, in the adult circulatory category, 6.6 percent of patients experienced at least one PPC, while in the adult mental health category the rate was 0.6 percent.
  
  
• Paying for outcomes. Texas Medicaid is one of several payers that measures PPCs and provides incentives for PPC reductions.
  
  
• Informing collaboration. In New York State, a hospital collaborative used PPCs to identify and improve hospital performance. For example, the collaborative found that patients who developed PPCs were three to four times costlier to treat than patients without a PPC who had the same diagnosis and severity of illness.

Solventum PPC logic is the same for every user, although different users may use different versions or choose not to report certain Solventum 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, Solventum does not offer any payer-specific PPC software.

Solventum PPCs are integrated with other Solventum patient classification methodologies.

• Solventum PPCs are identified from claims grouped using the Solventum™ All Patient Refined DRG (APR DRG) methodology. Solventum APR DRG are used to risk adjust PPC rates across hospitals or other inpatient populations.
• The latest version of Solventum IR-DRGs uses the full capacity of the ICD-10-CM diagnosis and intervention codes. This helps to link with indicators from the Solventum™ Potentially Preventable Complications (PPCs) Classification System to identify present-on-admission flags and generate admission and discharge data for the Solventum IR-DRGs.
• Solventum PPCs are one of the five Solventum potentially preventable events. The others are potentially preventable readmissions, admissions, emergency department visits and services.

Solventum PPCs are available in the following Solventum products:

• Solventum™ 360 Encompass™ System
• Solventum™ Reimbursement Calculation Software
• Solventum™ Core Grouping Software (CGS)
• Solventum™ Grouper Plus Content Services (GPCS)
• Solventum™ Data-to-Action (DTA) Solution
• Solventum™ Severe Maternal Morbidity Classification System

Available to software licensees on the Solventum customer support website:

• PPC Definitions Manual
• PPC Summary of Clinical Logic Updates
• PPC Norms and Weights Files (Microsoft® Excel file)
• Evaluating the Quality of POA Reporting in Hospital Claims Data

Solventum experts are available to advise hospitals, health plans, government agencies, and other interested parties on how to obtain maximum value from the use of Solventum PPCs. For example, Solventum consultants can help hospitals measure the incidence of potentially preventable complications, compare against benchmarks, and help design programs for improvement. Solventum 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 Solventum 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 Solventum™ 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, Solventum recommends that any Solventum PPC analysis include an evaluation of the likely accuracy of POA indicators. Suggested criteria are available on the Solventum customer support website.

Despite advancements in modern hospital care, quality problems remain, impacting patient outcomes and provider costs. In the early 2000s, Solventum 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, Solventum 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.

Solventum PPC 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 Solventum 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 Solventum 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, Solventum researchers found that approximately nine percent of hospital inpatient cost was due to potentially preventable complications.

The Solventum 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 Solventum 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 Solventum PPCs are identified through diagnosis and procedure codes listed on standard claim forms. The Solventum-proprietary clinical logic is maintained by a team of Solventum clinicians, data analysts, nosologists, programmers and economists and can be viewed by software licensees in an online definitions manual. Solventum 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.