Solventum™ Ambulatory Potentially Preventable Complications (AM-PPCs) Classification System

AM-PPCs are complications that occur after an elective ambulatory procedure due to care and treatment processes rather than the natural progression of illness. In other words, these complications could be potentially prevented through improved clinical practices, surgical techniques or post-procedural management.

Solventum AM-PPCs were developed to address the existing gap in assessing the quality of outpatient care, specifically for procedures performed in outpatient care settings. The system adjusts for clinical relevance, establishing clear relationships between procedures and expected complications like infections, sepsis, significant bleeding and pneumonia. Exclusion criteria ensure complications are clinically relevant and timely. Complications are identified through subsequent hospital admissions, emergency department (ED) visits and other ambulatory encounters, and they are distinguished by care settings within performance evaluations.

Solventum AM-PPCs are built for health systems, 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. Solventum analysis of national Medicare data from 2021 to 2023 indicates that 2.4% of all ambulatory procedures result in at least one potentially preventable complication, representing thousands of avoidable events annually. However, the risk varies depending on the procedure. For instance, routine cataract surgeries have a complication rate of only 0.53%, whereas high-risk procedures such as percutaneous nephrostomy placement exhibit rates as high as 19.5%. This variation highlights the necessity for procedure-specific monitoring and targeted improvement strategies. 
  
• Support public reporting. State departments, hospitals and quality agencies can post health reports or ratings on public websites.
  
• Reward outcomes. Payers can implement Solventum AM-PPC measures to incentivize reductions in potentially preventable complications.
  
• Informing collaboration. Solventum AM-PPCs can aid community collaboratives to make it easier for hospitals and community organizations to develop and lead interventions that promote healthcare quality.

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 using 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, ED visits or other ambulatory encounters. All the data required for 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 with a consistent identifier for the patient. 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 and line-item revenue codes. 

Despite advancements in modern hospital care, quality problems remain, impacting patient outcomes and provider costs. In the early 2000s, Solventum (formerly 3M Health Care) assembled a team to develop a methodology to identify situations in which inpatient hospital care was less than excellent. The resulting methodology, the Solventum™ Potentially Preventable Complications (PPCs) Classification System, was first published in the Health Care Financing Review in 2006. Since then, this methodology has been regularly updated and increasingly adopted across the U.S. 

The implementation and success of inpatient Solventum PPCs prompted Solventum to also assess the quality of outpatient care, especially given the growing industry need. Even as more procedures shift to the outpatient setting, there remains a lack of outcome reporting and universal standards for tracking complications from ambulatory procedures. Moreover, data is fragmented across the care settings where procedures are performed and where patients seek care when experiencing complications. In 2015, Solventum researchers sought to address these challenges and reassembled a team to develop Solventum AM-PPCs. This methodology can evaluate ambulatory procedures that resulted in complications of care within a longitudinal analysis using a designated timing window (e.g., 30 days).

Using diagnosis and procedure codes listed on standard claim forms, Solventum AM-PPCs apply sophisticated clinical logic to identify procedures and clinically categorize them within distinct procedure subgroups (PSGs) that comprise common elective procedures often performed in outpatient care settings. Additionally, the system identifies unique complications — such as sepsis, pneumonia and lung infections, pulmonary embolism, venous thrombosis, hemorrhage and device related infections or mechanical complications — and classifies them into clinically meaningful groups.

The Solventum AM-PPC software identifies preventable complications by linking an ambulatory procedure to subsequent admissions, ED visits or other encounters with complication diagnoses. It matches these events with a predefined list of procedure-specific complications and timing guidelines. Complications unrelated to the initial procedure or occurring outside the expected timeline are excluded.

The Solventum AM-PPC proprietary clinical logic is maintained by a team of Solventum clinicians, data analysts, clinical analysts, programmers and economists and can be viewed by software licensees in an online definitions manual. Solventum plans to release a new Solventum AM-PPC version every February to reflect updates to the ICD-10 diagnosis and procedure code sets and the HCPCS code set, as well as to include enhancements in the clinical classification logic.