The challenge in readmission policy has always been to differentiate readmissions that were potentially avoidable from those that were not. In the early 2000s, Solventum developed the Solventum™ Potentially Preventable Readmissions (PPR) methodology. In 2007, the Medicare Payment Advisory Commission used the Solventum methodology to report that 13.3 percent of Medicare inpatients had a PPR within 30 days, costing the Medicare program $12 billion in 2005. In 2008, Solventum researchers published the PPR methodology in the Health Care Financing Reviewopens in a new tab. This article has been cited 250 times as the Solventum PPR classification system has spread across the U.S.
As with the other Solventum™ Potentially Preventable Events (PPEs) Classification Systems, three core concepts are essential:
- We recognize that not all readmissions are potentially preventable.
- What matters is not the individual readmission but rather the overall rate of potentially preventable readmissions. Instead of an approach to quality of “this should never happen,” Solventum uses a more realistic and meaningful approach of “this has happened too often.”
- Any comparisons across hospitals, health plans, attending physicians or any other patient populations must be risk-adjusted.
The Solventum PPR methodology starts by assigning every inpatient stay to a Solventum™ All Patient Refined Diagnosis Related Group (APR DRG). The basic Solventum PPR approach is to decide whether each combination of the initial admission Solventum APR DRG and the readmission Solventum APR DRG has a plausible clinical connection that indicates a potentially preventable readmission. That approach was supplemented by extensive clinical logic to add precision in identifying Solventum PPRs.
Patient
| Clinical Scenario (by APR DRG)
| Potentially Preventable Readmission?
| Comment
|
1
| Admission 1: Pneumonia
Admission 2: Fracture of Femur
| No
| Readmission not clinically related
|
2
| Admission 1: Resp. Malignancy
Admission 2: Pneumonia
| No
| Global exclusion 136
|
3
| Admission 1: Pneumonia
Discharge status: Left against medical advice
Admission 2: Pneumonia
| No
| Patient left against medical advice
|
4
| Admission 1: Pneumonia
Discharge status: Transfer to another acute care hospital
Admission 2: Heart Failure
| No
| Transfers are not readmissions
|
Note: All admissions are assumed to be within the designated window, e.g., 15 days or 30 days
|
The Solventum PPR classification system may be most easily understood by looking at the table above. For example, readmissions are not considered potentially preventable:
- If they are unrelated to the initial admission (Patient 1)
- If the patient has certain conditions like metastatic cancer (Patient 2)
- If the initial discharge was against medical advice (Patient 3) or was a transfer to another acute care hospital (Patient 4)
The PPR software shows which specific inpatient stays were considered potentially preventable, in each case with a defined reason for the assignment. These detailed data have proven very useful to clinicians and healthcare managers in taking action to improve outcomes. For example, a common finding is that the risk of a PPR peaks at two or three days after discharge.
Further information on the Solventum PPR logic is shown in an online definition manual available to all licensed clients.
The Solventum PPR logic is maintained by a team of Solventum clinicians, data analysts, nosologists, programmers and economists. The methodology is updated annually to reflect changes in the standard diagnosis and procedure code sets as well as Solventum enhancements to the clinical logic.
