SoonerCare 2016 readmissions penalty data available

Posted on: 4/26/17

The Oklahoma Health Care Authority (OHCA) has completed analysis of calendar year 2016 data for the Hospital Potentially Preventable Readmissions (PPR) program.

The OHCA uses software developed by 3M to objectively quantify the number of PPRs that would be expected for an individual hospital, based on statewide data. This hospital-specific PPR rate takes into account the DRGs, age groups, and behavioral health comorbidities associated with each hospital’s case mix. Several other state Medicaid programs also use 3M’s software to identify and help reduce PPRs.

The OHCA has established a target PPR rate for 2016 data that is 101 percent of the PPR rate of a hospital performing at the statewide average. Hospitals performing above the target rate will be assessed a penalty based on the number of PPR chains above that rate. Hospitals below the target rate will have no penalty assessed.

Hospitals may be assessed a penalty. The penalty per hospital will vary and will be recouped over eight weeks beginning May 2017 and ending in June 2017. Per diem facilities (Freestanding Psychiatric Hospitals, Psychiatric Residential Treatment Facilities, IHS/Tribal) are included in the analysis but excluded from penalties, so these facilities may receive informational only data related to the program, but penalties will NOT be assessed.

For more information, see letter 2017-05 on OHCA’s Provider Reimbursement Notices page. (Rick Snyder)

OHA Partners with Qualivis 

Qualivis was developed as a collaborative effort among multiple state hospital associations to meet the temporary staffing needs of member hospitals and health systems.

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