![]() For some 3M APR DRGs, the 3M PPA logic also takes into account individual diagnoses and patient age. For the general population, approximately 41 base 3M APR DRGs are considered potentially preventable. ![]() Identify patients with potentially preventable initial admissionsĪll inpatient stays are assigned to a 3M™ All Patient Refined Diagnosis Related Group (APR DRG). The 3M PPA logic is divided into two phases.ġ. In practice, that means that the actual 3M PPA experience of a population is compared with the experience that would be expected for a population with the same case mix. Instead of approaching quality with the mindset of “This should never happen,” we use a more realistic and meaningful approach of “This has happened too often.” Third, any comparisons across populations of patients must be risk-adjusted. Second, what matters is not the individual admission, but rather the overall rate of potentially preventable admissions. First, we recognize that not all admissions are potentially preventable. (The others are Potentially Preventable Emergency Department Visits and Potentially Preventable Services.)Īs with all 3M PPE methodologies, three core concepts are essential. In 2012, 3M met this challenge by releasing the 3M™ Potentially Preventable Admission methodology as one of the three Population-focused Preventables. ![]() The challenge has been to define “preventable” with an understanding that the preventability of these admissions depends on the overall burden of illness of the individual patient. Payer-specific grouping and reimbursement calculation softwareĮvery preventable hospital admission represents both a significant cost to the health care system and evidence of an ambulatory care system failure.One implication: Medicare’s method of assigning nursing facility SNF quality scores should say more about outcomes. In analyzing data for more than 400,000 Medicare nursing facility residents, 3M researchers found considerable variation both within and across states in risk-adjusted 3M PPA rates. The Texas Medicaid program reports risk-adjusted 3M PPA rates for Medicaid-managed care organizations along with detailed drill-down capability and downloadable data files. In a series of 2018 reports, the Florida Medicaid program used 3M methodologies (including 3M PPA) to publish risk-adjusted PPA rates for every region of the state. In a 2014 report to Congress on the Medicare program, the Medicare Payment Advisory Commission (MedPAC) used 3M PPA to calculate that 28 percent of inpatient stays were defined as potentially preventable, suggesting that “ample opportunities” existed for improvement in the ambulatory care provided to Medicare beneficiaries. Quantifying opportunities for improvement.In addition, this program reports risk-adjusted 3M PPA rates for Medicaid-managed care organizations, offering detailed drill-down capability and downloadable data files. That reduction translated into 7,236 fewer inpatient stays in 2017. Through concerted effort, the Texas Medicaid STAR managed care program reduced the 3M PPA rate by 35 percent, going from 14 PPAs per 100 stays in 2012 to 9 nine PPAs per 100 stays in 2017. Improving quality and managing managed care.Here are a few examples of how the 3M PPA methodology has benefited customers.
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