CMS data can misidentify admissions for decompensated HF

NATIONAL HARBOR, Md. — Identification of admissions due to decompensated HF through administrative means frequently results in incorrectly labeled admissions, according to data presented at the Heart Failure Society of American Annual Scientific Meeting.

“HF hospitalizations are difficult to quantify because the presenting phenotype varies and no single confirmatory test exists,” researchers wrote in an abstract. “Hospitals typically use CMS administrative reports as surrogate markers of HF readmissions and quality performance.”

Researchers evaluated admissions at a single medical center from Aug. 15, 2013, to Jan. 31, 2015, for patients aged 65 years or older with Medicare fee-for-service benefits. Using electronic medical records, they analyzed HF-related admissions using CMS administrative reports, with admission identification based on a primary discharge diagnosis of HF, compared with a clinical definition that required an admission to meet three of the following four criteria in order to be attributed to HF:

an order for an IV diuretic;
patient history of an ICD-9 code for HF;
brain natriuretic peptide (BNP) > 500 pg/mL; and/or
diagnosis of decompensated HF at admission.

During the evaluated period, researchers identified 764 unique incidences of HF admission, including 440 identified using the CMS definition and 553 identified using the clinical definition. After excluding 229 admissions identified via both methods, the clinical definition identified 324 unique admissions compared with 211 unique admissions identified with the CMS definition. Sensitivity for use of the CMS definition was calculated at 54%.

Twenty-seven percent of the unique admissions identified through CMS were refuted on manual chart review, equating with false identification of HF in 13% of all admissions identified with the CMS definition, Zachary L. Cox, PharmD, from Vanderbilt University Medical Center and Lipscomb University College of Pharmacy, Nashville, said during a presentation.

Reasons for admissions commonly misidentified as HF included complications related to a left ventricular assist device (n = 12), implantation with a pacemaker or defibrillator (n = 13), the presence of noncardiac pain or dyspnea (n = 8) and ACS (n = 5).

"CMS administrative data definitions are not a reliable surrogate for HF admission quantification at an institution," Cox said. "We think this has two applications: First, CMS allows institutions to refute their 30-day readmission rate with supplementary data, so we feel this can be a low-resource way of changing a hospital's readmission rate. ... [Also], we feel that a clinical HF definition should be employed by institutions when looking at quality-improvement projects to accurately quantify and characterize their HF admission population."– by Adam Taliercio

References:

Cox ZL, et al. Rapid-Fire Abstracts I. Presented at: Heart Failure Society of America Annual Scientific Meeting; Sept. 26-29, 2015; National Harbor, Md.

Cox ZL, et al. J Card Fail. 2015;doi:10.1016/j.cardfail.2015.06.069.

Disclosure: Cox reports no relevant financial disclosures.