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 PPR classification system. In 2007, the Medicare Payment Advisory Commission used the Solventum classification system 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 classification systemopens in a new tab in the Health Care Financing Review. This article has been cited 250 times as the Solventum PPR has spread across the U.S.
As with the other Solventum™ Potentially Preventable Event 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 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: 139 Pneumonia
Admission 2: 340 Fracture of Femur
| No
| Readmission not clinically related
|
2
| Admission 1: 136 Resp. Malignancy
Admission 2: 139 Pneumonia
| No
| Global exclusion 136
|
3
| Admission 1: 139 Pneumonia
Discharge status 07: Left against medical advice
Admission 2: 139 Pneumonia
| No
| Patient left against medical advice
|
4
| Admission 1: 139 Pneumonia
Discharge status 02: Transfer to another acute care hospital
Admission 2: 194 Heart Failure
| No
| Transfers are not readmissions
|
5
| Admission 2: 134 Peat Failure
| Yes
| Readmission possibly clinically related
|
| Note: All admissions are assumed to be within the designated window, e.g., 15 days or 30 days |
The Solventum PPR methodology 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)
Patient 5 does have a potentially preventable readmission, because heart failure is a chronic condition that would have been present and managed in the initial admission. Results from the Solventum PPR software can then be used to draw comparisons, taking into account differences in case mix across different populations. Case mix adjustment reflects not only the reason for the admission but also the severity of illness.
In 2019, Solventum enhanced the PPR method by adding PPR ED logic to identify returns to the emergency department that did not result in an inpatient readmission. Previously, there was no widely available methodology to track this useful quality measure of inpatient care and of follow-up care in the community. In parallel with the Solventum PPR approach, the PPR ED logic distinguishes ED visits that were and were not clinically related to an initial inpatient stay within a specified window, such as 15 or 30 days. The PPR ED logic uses diagnosis information from the ED claim to assign the visit to a Solventum APR DRG, which is compared with the Solventum APR DRG for the initial admission. As with Solventum PPRs, supplemental logic adds precision in identifying potentially preventable revisits to the ED.
The PPR and PPR ED software shows which specific inpatient stays and ED visits 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 and PPR ED logic is shown in an online definition manual available to all licensed clients.
The Solventum PPR and PPR ED clinical 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.
