The BPCI Metrics table contains the basic metrics necessary to evaluate SNF performance by BPCI Clinical Episode. You can use the data for identifying a competitive advantage or areas for internal improvement. The table contains some standard patient oriented metrics broken out by the BPCI Clinical Episodes of Care under which the care provided was reimbursed. There are 48 BPCI Clinical Episodes (listed at the bottom of this article) but only those BPCI Clinical Episodes that reflect claims for 11 or more patients will be included in the table.
If you add up the "Admit Count" column, the total number of patients will not equal the total patient counts in other tables on the same page. This is not an error, not all inpatient Medicare claims included in the 48 chosen Clinical Episodes, so it is likely that overall counts in this table will be smaller.
Two immediate uses for the metrics in this table:
- Compare to the competition: Look at specific metrics in this table side by side with another SNF to find BPCI Clinical Episode types where your SNF provides better care. All of the metrics in this table strongly invite comparison in this way. This allows you to create a success story to use when engaging hospital partners.
- Identify areas requiring growth: All Trella Health metrics should be used for self evaluation. Compare specific metrics to benchmark averages, Medicare requirements, or internal performance goals your SNF has set.
We break out the metrics with reference to a single BPCI Clinical Episode type to yield the most refined and illuminating metric for comparison with other SNFs. At the same time, this greater precision comes with the cost of producing overall smaller results for each type which is why so many Episode types end up in the category Aggregated INS BPCIs (see note below).
Admit Counts - This general metric allows you to gain an overall view of the patient mix of the Medicare patients you treat. This could confirm or reveal areas of specialization and expertise, and allow you to present your SNF to your hospital partners as the specialist they need.
Average Length of Stay - This is an important metric to use as a differentiator to demonstrate your SNFs ability to contain costs. We provide the parallel State ALOS for each row to provide another point for comparison. In the case of ALOS, smaller is always better.
Readmit Rates - The 30 day readmit rate is a heavy hitter for hospitals, and failure to keep this metric in check can potentially jeopardize your referral relationship with a hospital partner. For BPCI Clinical Episodes where your SNF is doing well at controlling readmits, that is a strong message to keep before your hospital partners. In addition, SNFs need to know about all patients who are being admitted to any hospital within 90 days of the most recent hospital discharge, so we have included a break out for 30, 60, and 90 days.
Average SNF Reimbursement - This column contains the average reimbursement amount, per patient for the BPCI Episode type listed in each row. This metric is best used to compare with your competitors, and success in this area could also provide a strong incentive for an improved partnership with a hospital.
Understanding the Metrics
Patients are aligned with a specific BPCI Episode based on the diagnosis from the discharging Inpatient stay.
|BPCI||This column will contain those BPCI Clinical Episode names that reflect claims for 12 or more patients. All metrics in the same row include metrics for patients with the listed Clinical Episode type.|
|Admit Count||This metric is the number of patients admitted to the SNF in the most recent 4 quarters for the BPCI Clinical Episode listed in each row.|
|ALOS||This column shows the average length of stay in days for patients discharged from the SNF during the last 8 quarters for the BPCI Clinical Episode listed in each row.|
|State ALOS||The State ALOS provides a comparison average for lengths of stay for all SNFs in the State. This is also a 2 year metric.|
|Readmit Rates||This metric is the percentage of patients who came from an inpatient setting into this skilled nursing facility and were subsequently readmitted to another inpatient setting within 30, 60, or 90 days of the inpatient discharge that initiated SNF care.|
|Average SNF Reimbursement||Average of all Medicare reimbursement for all patients admitted during the 2 year period for the BPCI Clinical Episode listed in each row.|
Aggregated INS BPCIs
In the table you will almost always see an entry in the BPCI column called Aggregated INS BPCIs, which represents the combined percentage of all BPCI Clinical Episodes that are too small to be presented on their own. In any case where the total number of patients in a specific count drops below 11 patients, we can't show that number for privacy reasons. We roll all the Clinical Episodes that represent counts <11 into this one category and present that count with this header. In sum, this row includes all entries that have insufficient counts aggregated into a single metric.
Because this row is an unknown mix of clinical episodes and MS-DRGs you can't use the metrics in this row for a direct comparison with another Skilled Nursing Facility. There is no reason to believe that what is included in this metric for two different SNFs would be similar in any way. You should also not compare these metrics from one quarter to the next or previous quarter because the BPCIs included in this metric can change over time.
Complete list of BPCI Clinical Episodes of Care (48)
|The 48 BPCI Clinical Episodes of Care are listed in this table alphabetically. If you hover over a cell containing an episode name, a pop-up will show the related DRGs for that Episode.|
|Acute myocardial infarction||Combined anterior posterior spinal fusion||Major bowel||Percutaneous coronary intervention|
|Amputation||Complex non-Cervical spinal fusion||Major cardiovascular procedure||Red blood cell disorders|
|Atherosclerosis||Congestive heart failure||Major joint replacement of the lower extremity||Removal of orthopedic devices|
|Automatic implantable cardiac defibrillator generator or lead||Coronary artery bypass graft surgery||Major joint replacement of upper extremity||Renal failure|
|Back and neck except spinal fusion||Diabetes||Medical non-infectious orthopedic||Revision of the hip or knee|
|Cardiac arrhythmia||Esophagitis, gastroenteritis and other digestive disorders||Medical peripheral vascular disorders||Sepsis|
|Cardiac defibrillator||Double joint replacement of the lower extremity||Nutritional and metabolic disorders||Simple pneumonia and respiratory infections|
|Cardiac valve||Fractures femur and hip/pelvis||Other knee procedures||Spinal fusion (non-Cervical)|
|Cellulitis||Gastrointestinal hemorrhage||Other respiratory||Stroke|
|Cervical spinal fusion||Gastrointestinal obstruction||Other vascular surgery||Syncope and collapse|
|Chest pain||Hip and femur procedures except major joint||Pacemaker||Transient ischemia|
|Chronic obstructive pulmonary disease, bronchitis/asthmae||Lower extremity and humerus procedure except hip, foot, femur||Pacemaker Device replacement or revision||Urinary tract infection|
Source: CMS.GOV - https://innovation.cms.gov/initiatives/bundled-payments/