Solventum™ Potentially Preventable Readmissions (PPRs) Classification System

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. Solventum Potentially Preventable Readmissions may result from actions taken or omitted during the initial hospital stay, such as incomplete treatment or poor care of the underlying problem, or from poor coordination of services at the time of discharge and afterwards, such as incomplete discharge planning or inadequate access to care.

Solventum PPRs are most often used by government agencies, integrated care organisations, trusts, hospitals 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:

• Improving quality. Through concerted effort, Minnesota hospitals prevented more than 7,000 readmissions over a two-year period. Over 80 hospitals participated in a learning collaborative, using Solventum PPRs to track progress and provide detailed quarterly reports to each hospital. Learn more about Minnesota hospital results using PPRs.
  
  
• Public reporting. The New York Department of Health reports risk-adjusted PPR rates for each hospital on its website. 
  
  
• Enabling insight. In an all-payer analysis in Rhode Island, 6.3 percent of inpatients experienced at least one potentially preventable readmission. PPR rates varied by category, from 1.1 percent for obstetrics to 12.6 percent for adult mental health and/or substance abuse conditions. Two-thirds of readmissions were to the same hospital, but that percentage also varied by category. Learn more about Rhode Island PPRs (PDF, 2.7 MB).
  
  
• Paying for outcomes. Texas Medicaid is one of several payers that measures PPRs and incentivizes reductions. Learn more about Texas Medicaid PPR measures. 
  
  
• Monitoring hospital and managed care performance. The Ohio Medicaid program uses Solventum PPRs to monitor hospital and managed care plan performance by comparing the actual number of PPRs with the number that would be expected for a hospital or plan of the same case mix.

Solventum PPRs are integrated with the other Solventum patient classification methodologies:

Solventum PPRs are identified from clinical records grouped using functionality embedded within Solventum™ All Patient Refined Diagnosis Related Groups (APR DRGs) Classification System. Solventum APR DRGs are also used to risk adjust PPR rates across hospitals or other inpatient populations.

Solventum PPRs are one of the five Solventum™ Potentially Preventable Events (PPEs) Classification Systems.
The others are:

• Solventum™ Potentially Preventable Complications (PPCs) Classification System
• Solventum™ Potentially Preventable Admissions (PPAs) Classification System
• Solventum™ Potentially Preventable Emergency Department Visits (PPVs) Classification System
• Solventum™ Potentially Preventable Services (PPS) Classification System

Solventum PPRs are available in the following Solventum products:

• Solventum™ 360 Encompass™ System
• Solventum™ Coding and Reimbursement System (CRS)
• Solventum™ Advanced CDI Transformation Services 
• Solventum™ Clinical Documentation Improvement Solution
• Solventum™ Core Grouping Software (CGS)
• Solventum™ Grouper Plus Content Services (GPCS)
• Solventum™ Data-to-Action (DTA) Solution 

Available to licensees on the Solventum customer support website (covering both PPRs and PPR EDs):

• PPR Methodology Overview
• PPR Definitions Manual
• PPR Norms File (Excel)
• PPR Setup Guide

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 PPRs. For example, Solventum consultants can help hospitals measure the incidence of potentially preventable readmissions, compared against regional, national and international benchmarks and help design programs for improvement. Solventum consultants can also help integrated care organisations facilitate learning collaboratives to improve PPR performance and drive better outcomes for the patients they serve.

Each inpatient stay is first assigned to a Solventum™ 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 and procedure codes. Because there are several reasons why a patient may have more than one inpatient encounter 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).

The challenge in readmission policy has always been to differentiate readmissions that were potentially avoidable from those that were not. In the early 2000s, Solventum developed the Solventum™ Potentially Preventable Readmissions (PPR) methodology. In 2007, the Medicare Payment Advisory Commission used the Solventum 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, Solventum researchers published the PPR methodology in the Health Care Financing Review. This article has been cited 250 times as the Solventum PPR classification system has spread across the U.S.

As with the other Solventum™ Potentially Preventable Events (PPEs) Classification Systems, three core concepts are essential:

1. We recognize that not all readmissions are potentially preventable.
2. What matters is not the individual readmission but rather the overall rate of potentially preventable readmissions. Instead of an approach to quality of “this should never happen,” Solventum uses a more realistic and meaningful approach of “this has happened too often.”
3. Any comparisons across hospitals, health plans, attending physicians or any other patient populations must be risk-adjusted.

The Solventum PPR methodology starts by assigning every inpatient stay to a Solventum™ All Patient Refined Diagnosis Related Group (APR DRG). The basic Solventum PPR approach is to decide whether each combination of the initial admission Solventum APR DRG and the readmission Solventum APR DRG has a plausible clinical connection that indicates a potentially preventable readmission. That approach was supplemented by extensive clinical logic to add precision in identifying Solventum PPRs.

The Solventum PPR classification system may be most easily understood by looking at the table above. For example, readmissions are not considered potentially preventable: 

• If they are unrelated to the initial admission (Patient 1)
• If the patient has certain conditions like metastatic cancer (Patient 2)
• If the initial discharge was against medical advice (Patient 3) or was a transfer to another acute care hospital (Patient 4)

The PPR software shows which specific inpatient stays 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 Solventum PPR logic is shown in an online definition manual available to all licensed clients.

The Solventum PPR logic is maintained by a team of Solventum 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 Solventum enhancements to the clinical logic.