Mortality Measures Overview
Publicly reporting risk-standardized, 30-day mortality measures for AMI, HF, and PN
The Deficit Reduction Act (DRA) of 2005 mandated that the Secretary of Health and Human Services make outcome and efficiency measures publicly available under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program. To improve the quality of our nation’s hospitals, and in response to the requirements of the DRA, the Centers for Medicare & Medicaid Services (CMS) publicly reports annually risk-standardized 30-day mortality measures for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN) patients. CMS provides hospitals with detailed information on their performance and posts summary results for these measures on the website Hospital Compare (http://www.hospitalcompare.hhs.gov).
The 30-day mortality measures focus on Medicare Fee-for-Service patients, at least 65 years of age, with a principal diagnosis of AMI, HF, or PN. These conditions are common among the Medicare beneficiary population, are associated with substantial mortality and morbidity, and have considerable variation in outcomes across U.S. hospitals. Mortality within 30 days can be strongly influenced by hospital care and the initial transition to outpatient status. The mortality measures complement the process-of-care quality measures also reported on Hospital Compare and three readmission measures for AMI, HF and PN that CMS added to the Hospital Compare website in July 2009. These measures increase the transparency of care for consumers and encourage hospitals to investigate their patient outcomes to assure that they are providing the right care for every patient, every time.
Background and Process
The risk-standardized AMI, HF, and PN mortality measures were developed by a team of clinical and statistical experts from Yale and Harvard universities, using a methodology that has been published in peer reviewed literature. The measures comply with standards for publicly reported outcomes models set forth by the American Heart Association and the American College of Cardiology. All three measures have been endorsed by the National Quality Forum and adopted for reporting by the Hospital Quality Alliance. The measures are updated annually to ensure the models are performing well, given trends in the underlying data. Also, prior to public reporting of these measures, CMS conducted national dry runs to educate hospitals about the measure methodology and respond to their questions and comments.
Hospital-Specific Reports (HSRs) are distributed to participating hospitals for each annual preview period prior to public reporting on Hospital Compare. Each hospital’s report describes the measures’ calculation methodology, lists patients considered for and those included in the analysis, and presents the results for that hospital.
Questions and Comments
CMS has contracted with Mathematica Policy Research, Inc., to implement these measures. Questions about the mortality measures may be sent to Mathematica at: mortalitymeasures@mathematica-mpr.com.