3M™ Ambulatory Potentially Preventable Complications (AM-PPCs)

A complication of care (e.g., pneumonia, sepsis) following an ambulatory procedure that may result from processes of care and treatment rather than from natural progression of an underlying illness and are therefore potentially preventable.

Solventum AM-PPCs are built for health systems, ambulatory surgical centers, payers, quality agencies, government agencies and researchers. A hospital can use the Solventum AM-PPC methodology on its own for the outpatient department; for example, the hospital can calculate its own Solventum AM-PPC rates in a base year and then work to improve future performance. Hospitals, payers, quality agencies, government agencies and researchers typically undertake analyses of multi-hospital data sets to compare performance and identify opportunities for improvement.

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

• Improve quality. Solventum AM-PPCs are designed to provide comparative ambulatory procedure complication rates across ambulatory care settings. Higher than expected complication rates may indicate opportunities to improve the quality of care at both the time of the initial procedure and in the post-procedural management of patients.
  
  
• Enable insight. In an analysis of Medicare data, two percent of procedures performed in ambulatory care settings experienced at least one potentially preventable complication*; however, rates varied by the type of procedure. For example, upper genitourinary procedure complication rates are as high as 13 percent, and this varies to less than one percent for more routine procedures like colonoscopies*.
  
  
• Public reporting. State departments, hospitals and quality agencies can post health reports or ratings on public websites.
  
  
• Paying for outcomes. Payers can implement Solventum AM-PPC measures to provide incentives for reductions in potentially preventable complications.
  
  
• Informing collaboration. Solventum AM-PPCs can be used to aid community collaboratives to make it easier for hospitals and community organizations to develop and lead interventions that promote health care quality.

*Analysis conducted by Solventum using National Medicare Data from 2019-2020 and State Medicaid Data Statistics from 2018-2021

Solventum AM-PPCs logic is the same for every user, although different users may choose not to report certain AM-PPCs. Each user makes their own decisions about appropriate use, including risk adjustment and comparison of individual hospital performance with an appropriate benchmark.

Solventum AM-PPCs are integrated with other Solventum patient classification methodologies. Solventum AM-PPCs can be identified from certain inpatient claims using the Solventum™ All Patient Refined Diagnosis Related Groups (APR DRGs) Classification System. Solventum APR DRGs are used in identifying complications of care for inpatient claims that contain an ambulatory procedure performed prior to admission. This is relevant for inpatient claims subject to the three-day payment rule or 72-hour payment rule.

Solventum AM-PPCs are available in the following Solventum products: 

• Solventum™ Core Grouping Software (CGS)
• Solventum™ Grouper Plus Content Services (GPCS)
• Solventum™ Data-to-Action Solution

Available to software licensees on the Solventum customer support website

• Solventum AM-PPCs Definitions Manual
• Solventum AM-PPCs Summary of Clinical Logic Updates
• Solventum AM-PPCs Norm Files (Microsoft Excel File)

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 AM-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 AM-PPCs across hospitals, design pay for outcomes incentive methods, and facilitate learning collaboratives to reduce AM-PPCs and improve care.

The unit of analysis is an ambulatory encounter in which an elective procedure is performed and may be followed by a complication of care within subsequent hospital admissions, emergency department visits or other ambulatory encounters. All the data required to do a Solventum AM-PPC analysis can be obtained from a standard outpatient, professional or inpatient hospital/provider claim, such as the UB-04 form or the X12N, 837I, 837P electronic transaction.

Individual records must be linked using consistent identifiers for both the patient and the hospital/provider. Data fields that are particularly important include claim bill type or place or service, all diagnosis codes, present on admission (POA) indicators for inpatient claims, ICD-10-PCS procedure codes, procedure code dates, line-item HCPCS/CPT® procedure codes with service dates, line-item revenue codes to identify ED visits (045x). Because it is important whether a diagnosis was present on admission for inpatient admissions, Solventum recommends that any AM-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 inpatient hospital care was less than excellent. The resulting methodology, the inpatient Solventum™ Potentially Preventable Complications (PPCs) Classification System, 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 implementation and success of inpatient PPCs have allowed for Solventum to shift its focus to assess the quality of outpatient care. In 2015, Solventum researchers reassembled a team to develop Solventum AM-PPCs, a methodology that could evaluate ambulatory procedures that resulted in complications of care within a longitudinal analysis using a designated timing window (e.g., 30 days).

The Solventum AM-PPCs apply sophisticated clinical logic to identify more than 2,900 procedures and clinically categorize them within 93 distinct procedure subgroups (PSGs). PSGs are comprised of common elective procedures often performed in outpatient care settings. There are 35 potentially preventable complication groups, which include more than 1,200 complications such as: sepsis, pneumonia and lung infections, pulmonary embolism, venous thrombosis, hemorrhage and hematoma and device related infections or mechanical complications.

Potentially preventable complications are identified by the Solventum AM-PPC software by linking an ambulatory procedure to a subsequent admission, emergency department visit, or other ambulatory encounter reporting a complication diagnosis code, in timeline sequence and matching a predefined procedure-specific complication list and timing guidelines. Complications that are not related to the initial procedure or that present prior to the date in which they are expected to occur are excluded by the Solventum AM-PPC logic.

AM-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 definition’s manual. Solventum plans to release a new Solventum AM-PPC version every Oct. 1, to reflect updates in the ICD-10 diagnosis and procedure code sets and to include enhancements in the clinical classification logic.