Incorporating Present-on-Admission Indicators in Medicare Claims to Inform Hospital Quality Measure Risk Adjustment Models

Key Points Question Could present-on-admission indicators enhance risk models used by the Centers for Medicare & Medicaid Services to assess acute myocardial infarction, heart failure, and pneumonia mortality and readmission measures? Findings In this comparative effectiveness study including all Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, heart failure, or pneumonia at acute care hospitals, the incorporation of present-on-admission indicators into patient-level and hospital-level 30-day mortality and readmission risk models was associated with modest improvement of discrimination in model performance. Meaning These results suggest that accounting for preexisting conditions in hospital quality outcome data could enhance mortality and readmission measure risk models while incurring no additional burden to health care professionals.