Potentially preventable events are encounters, which could be prevented, that lead to unnecessary services or contribute to poor quality of care. They are described below. The Distinguishing PPE Programs Chart will help distinguish the different program areas that run these metrics.

  • Potentially preventable emergency room visit: Emergency treatment for a condition that could have been treated or prevented by a physician or other health care provider in a nonemergency setting.
  • Potentially preventable hospital readmission: A return hospitalization, within a set time, that might have resulted from problems in care during a previous hospital stay or from deficiencies in a post-hospital discharge follow-up.
  • Potentially preventable hospital admission: A hospital admission or long-term care facility stay that might have been reasonably prevented with adequate access to ambulatory care or health care coordination.
  • Potentially preventable complication: A harmful event or negative outcome, such as an infection or surgical complication, that occurs after a hospital admission or an LTC facility stay and might have resulted from care, lack of care or treatment during the admission or stay.

Hospital Quality-based Potentially Preventable Readmissions and Complications Program

Texas Health and Human Services collects data on potentially preventable events and uses it to improve quality and efficiency.

Managed care organizations and hospitals are financially accountable for potentially preventable complications and potentially preventable readmissions flagged by HHS.

Based on performance for these measures, adjustments are made to fee-for-service hospital inpatient claims. Similar adjustments are made in each MCO’s experience data, which affects capitation rates.

Announcements

Resources

Fiscal Year 2017

Fiscal Year 2017 MID-Year

Note: This reporting period is for informational purposes only and not associated with any reimbursement reductions.

Fiscal Year 2016

Fiscal Year 2015

Safety-Net Incentive Component

Data

Webinars

Jan 30, 2018, Hospital Quality-Based PPR PPC Refresher

June 1, 2016, PPR and PPC Safety-Net Incentive Component

Note: For an accessible version, or more information please email the PPR PPC Coordination Team