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Plan All-Cause Readmissions (PCR)

For patients 18 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission. Data are reported in the following categories:
1. Count of Index Hospital Stays* (denominator)
2. Count of 30-Day Readmissions (numerator)
3. Average Adjusted Probability of Readmission
*An acute inpatient stay with a discharge during the first 11 months of the measurement year (e.g., on or between January 1 and December 1).

Date Reviewed: April 1, 2021
Do Not Support: Uncertain Validity
    ACO
Support
    Health Plan

Measure Info

NQF 1768
Measure Type
Outcome
Measure Steward
National Committee for Quality Assurance
Clinical Topic Area
Readmission
Care Setting
Inpatient/Hospital
Other
Data Source
Claims Data
Patient Reported Data and Surveys

ACP does not support former NQF 1768 - "Plan All-Cause Readmissions (PCR)" for application at the actual/intended level of analysis: 鈥淎CO鈥 because of uncertain validity. However, ACP supports NQF 1768 - "Plan All-Cause Readmissions (PCR)" for application at the actual/intended level of analysis: 鈥淗ealth Plan鈥 because the measure is valid. The importance and impact of the measure is in question and there is no evidence to demonstrate its impact on health outcomes.  There are no concerns regarding the gaming issues that are present with other readmission measures given the level of accountability and the financial alignment.  The risk adjustment models have not been provided, but likely do not include social determinants or measures of income.  The applicability is reasonable given that the measure intends to assess health plan performance and therefore would be applied by line of business, which includes Medicare but also includes commercial PPO, commercial HMO, and Medicaid.