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#ED VISITS LANE DISEASE DEFINITION HOW TO#
#ED VISITS LANE DISEASE DEFINITION SOFTWARE#

Of the 560 3M EAPGs (as of February 2019), many principal diagnoses within 196 3M EAPGs are considered potentially preventable in the general population. (Nationally, 14 percent of ED patients are admitted to the same hospital their ED services are included within the inpatient stay.) Learn more (PDF, 274.35 KB).Īll ED visits are grouped using the 3M™ Enhanced Ambulatory Patient Group (EAPG) methodology. Identify potentially preventable eventsīy definition, “ED visits” include only those visits where patients were treated and released.

The 3M PPV logic is divided into two phases.ġ. In practice, that means that the actual 3M PPV experience of a population is compared with the experience that would be expected for a population with the same case mix. Instead of approaching quality with the mindset of “This should never happen,” we use a more realistic and meaningful approach of “This has happened too often.” Third, any comparisons across populations of patients must be risk-adjusted. Second, what matters is not the individual visit, but rather the overall rate of potentially preventable ED visits. First, we recognize that not all ED visits are potentially preventable. (The others are 3M™ Potentially Preventable Admissions and 3M™ Potentially Preventable Services.)Īs with the other 3M Potentially Preventable Event methodologies, three core concepts are essential. In 2012, 3M met these challenges by releasing the 3M™ Potentially Preventable Emergency Department Visit (PPV) methodology as one of the three 3M™ Population-focused Preventables. Many payers have penalized the hospital or the patient for individual visits deemed inappropriate, but this approach can clearly be unfair.

#ED VISITS LANE DISEASE DEFINITION HOW TO#

The twin challenges have been exactly how to define “inappropriate” and who should be held responsible. Inappropriate use of the emergency department has long been identified as a major problem in the health care system.

#ED VISITS LANE DISEASE DEFINITION SOFTWARE#

Payer-specific grouping and reimbursement calculation software.

One implication: Medicare’s method of assigning nursing facility quality scores should say more about outcomes. In analyzing data for more than 400,000 Medicare nursing facility residents, 3M researchers found considerable variation both within and across states in risk-adjusted 3M PPV rates. The Texas Medicaid program reports risk-adjusted 3M PPV rates for Medicaid-managed care organizations along with detailed drill-down capability and downloadable data files. The New York Department of Health reports risk-adjusted 3M PPV rates by county for both the all-payer and Medicaid populations, with reports dating back to 2011.

In the Medicare program, 55 percent of ED visits (excluding those patients who are admitted) were defined as potentially preventable, suggesting to the Medicare Payment Advisory Commission (MedPAC) that “ample opportunities” exist for improvement in the ambulatory care provided to Medicare beneficiaries.

Quantifying opportunities for improvement.

Here are a few examples of the value the 3M PPV methodology can bring to customers.