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June 2016
New Medicare star ratings measure: Hospitalization for potentially preventable complications
Did you know?
Many studies have shown a correlation between chronic conditions and depression. According to a World Health Organization study, health scores worsened when depression was a comorbid condition. That’s why depression screening or referral to a behavioral health specialist can help improve health outcomes for patients with chronic conditions.
We want to provide you with information about a new star ratings measure: Hospitalization for potentially preventable complications, also called HPC.
About the measure
The HPC measure evaluates patients age 67 and older with a diagnosis of an ambulatory care-sensitive condition that occurred during an inpatient visit. ACSCs are acute or chronic health conditions that can be managed or treated in an ambulatory setting.
Hospital inpatient data is used to assess the health care system as a whole, evaluating the quality of ambulatory care in preventing medical complications. This provides valuable information in determining how well a system of care helps older adults with chronic and acute conditions.
High rates of hospitalizations for ACSCs could indicate that our Medicare Advantage members aren’t receiving high-quality ambulatory care. Because some complications are unavoidable, members with ambulatory care-sensitive conditions may be hospitalized. Measuring ACSC admissions can provide information for our health care providers that will help them improve outpatient care.
What do providers need to know?
Providers manage and treat patients with ACSCs on an outpatient basis to help them avoid hospitalization. Older adults can develop serious complications as a result of hospitalization.
Access to high-quality care and care coordination, a focus on chronic disease self-management and connection to community resources can reduce the chance that individuals with these chronic and acute conditions will develop complications resulting in hospitalization.
Ambulatory care sensitive conditions included in the measure**
Chronic ACSC |
Acute ACSC |
Diabetes short-term complications |
Bacterial pneumonia |
Diabetes long-term complications |
Urinary tract infection |
Uncontrolled diabetes |
Cellulitis |
Lower extremity amputation (diabetics) |
Pressure ulcer |
Chronic obstructive pulmonary disease |
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Asthma |
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Hypertension |
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Heart failure |
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To comply with Centers for Medicare & Medicaid Services star reporting, Blue Cross Blue Shield of Michigan will report MA PPO member hospitalizations for ACSCs in accordance with HEDIS® specifications.
**Exclusions apply. These include traumatic amputations, cystic fibrosis, congestive heart failure or hypertensive patients with a cardiac procedure or diagnosis of Stage 1 to Stage 4 kidney disease with a dialysis procedure, and patients who reside in a skilled nursing facility for 100 days or more during the measurement year.
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