Avoiding Hospitalizations: CMS moved our cheese

The Centers for Medicare & Medicaid Services (CMS) has discussed replacing Acute Care Hospitalization (ACH) and  Emergency department (ED) Use with Potentially Preventable Hospitalization (PPH) for several years and now has made the major step to get it done.

ACH and ED Use claims data currently comprise 35% of your Total Performance Scores (TPS). Even though your ACH and ED Use scores are being jettisoned in favor of the new PPH, the ACH and ED Use will still impact your payment until 2026. New to Value-Based Purchasing (VBP) are the PPH and the Discharged to Community (claims-based) quality measures, which together will comprise 35%. PPH will include hospitalizations (both ACH and LTCH) and observations stays. The DTC measure will include readmissions for up to 31 days after discharge.

Join our McBee experts Lisa Selman-Holman and Michelle Horner as they discuss what’s now and what’s new in the claims-based portion of Value-Based Purchasing.

Learning Objectives

• Contrast ACH and ED Use with PPH
• Describe the differences between Discharged to Community (OASIS based) and the Discharged to Community (claims-based)
• Discuss strategies for impacting outcomes in 2024 and beyond