Assesses hospital inpatient admissions and observation stays due to complications of ambulatory care-sensitive conditions (ACSC) among Medicare members 67 years of age and older. Health plans report observed ACSC hospitalization rates and expected ACSC hospitalization rates that take the member’s health history into account. Rates are used to calculate a calibrated observed-to-expected ratio of hospitalizations for potentially preventable complications of ACSC that assesses whether plans had more, the same or less hospitalizations than expected, while accounting for incremental improvements across all plans over time. The observed-to-expected ratio is multiplied by the hospitalization rate across all health plans to produce a risk-standardized rate which allows for national comparison.
Why it Matters
ACSCs can be acute (bacterial pneumonia, cellulitis, urinary tract infection, pressure ulcer) or chronic (diabetes, COPD, asthma, hypertension, heart failure). Hospital stays account for a large component of total health care costs for older adults and poses several risks, such as delirium, infection and decline in functional ability.1,2,3 Hospitalizations for complications of ACSC can be prevented with appropriate access to ambulatory care services, timely delivery of care and high-quality care coordination. Reducing the rate of hospitalization for older adults will improve patient health, reduce costs and improve quality of life.
Results – National Averages
Total: Chronic ACSC Rate
| Measure Year | Medicare HMO | Medicare PPO |
|---|---|---|
| 2022 | 22.2 | 18.4 |
| 2021 | 22.3 | 17.3 |
| 2020 | 22.5 | 18.2 |
| 2019 | § | § |
| 2018 | 25.0 | 22.6 |
Total: Acute ACSC Rate
| Measure Year | Medicare HMO | Medicare PPO |
|---|---|---|
| 2022 | 10.8 | 9.7 |
| 2021 | 10.4 | 9 |
| 2020 | 11.2 | 9.7 |
| 2019 | § | § |
| 2018 | 13.2 | 13.8 |
Total: ACSC Rate
| Measure Year | Medicare HMO | Medicare PPO |
|---|---|---|
| 2022 | 32.6 | 27.0 |
| 2021 | 32.4 | 26.3 |
| 2020 | 33.0 | 27.5 |
| 2019 | § | § |
| 2018 | 38.2 | 37.9 |
§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.
References
- Kaiser Family Foundation. An Overview of Medicare. Retrieved December 2, 2019, from The Henry J. Kaiser Family Foundation website: https://www.kff.org/medicare/issue-brief/an-overview-of-medicare/
- Gillick, M.R., N.A. Serrell, and L.S. Gillick. 1982. “Adverse consequences of hospitalization in the elderly.” Social Science & Medicine 16(10), 1033–8.
- Covinsky, K.E., E. Pierluissi, and C.B. Johnston. 2011. “Hospitalization-Associated Disability.” JAMA 306(16), 1782–93.