Outcomes Reports

Exploratory analyses and quality outcomes reporting using CMS inpatient claims

Hospital pay-for-performance programs and ratings such as the Hospital Readmissions Reduction Program, Hospital-Acquired Conditions Reduction Program, and the Centers for Medicare & Medicaid Services (CMS) Overall Hospital Quality Star Ratings rely on outcomes data from a handful of narrowly targeted conditions and procedures, such as acute myocardial infarction, heart failure and pneumonia.

However, more than 75% of Medicare fee-for-service inpatient encounters occur for other conditions or procedures that are not captured by these hospital quality rating programs. Such nontargeted conditions receive less research attention because their outcomes are not explicitly tied to public reporting. However, a holistic approach to improving the quality of hospital care requires examining all healthcare outcomes, including those not traditionally targeted for national measurement.

To this end, the Mayo Clinic Kern Center for the Science of Health Care Delivery's Science of Quality Measurement Program obtained a data use agreement permitting researchers to use retrospective Medicare inpatient claims data to explore risk-adjusted trends in readmission and mortality among Medicare beneficiaries.

The research team is examining the following factors:

• Patient-level factors for both targeted and nontargeted conditions.
• Patient-level factors for inpatient service lines such as cardiology or neurology.
• Patient-level factors for diagnosis-related groups.
• Institution-level factors such as geography, patient demographics and overall patient volume.

The data analysis will allow researchers to document granular trends or differential effects of patient outcomes that have not been previously examined in sufficient detail.

This page is updated approximately four times a year to contain information on various analyses and data derivations shared as a requirement of the data use agreement.

Analyses and outcomes reports

December 2023

• Exploring hospital resiliency by examining AHRQ PSI-04 rates early in the pandemic.

December 2022

• Measuring resiliency in hospital quality performance during the pandemic era.

June 2022

• The CMS Star Rating mortality domain score versus condition-specific mortality for common, but unmeasured, conditions.

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