3M™ Ambulatory Potentially Preventable Complications (AM-PPCs) Grouping Software

Here are a few examples of the value the 3M AM-PPC methodology can bring to customers:
 

• Improve quality. 3M AM-PPCs are designed to provide comparative ambulatory procedure complication rates across ambulatory care settings. Higher than expected complication rates may indicate opportunities to improve the quality of care at both the time of the initial procedure and in the post-procedural management of patients.
• Enable insight. In an analysis of Medicare data, two percent of procedures performed in ambulatory care settings experienced at least one potentially preventable complication*; however, rates varied by the type of procedure. For example, upper genitourinary procedure complication rates are as high as 13 percent, and this varies to less than one percent for more routine procedures like colonoscopies*.
• Public reporting. State departments, hospitals and quality agencies can post health reports or ratings on public websites.
• Paying for outcomes. Payers can implement 3M AM-PPC measures to provide incentives for reductions in potentially preventable complications.
• Informing collaboration. 3M AM-PPCs can be used to aid community collaboratives to make it easier for hospitals and community organizations to develop and lead interventions that promote health care quality.

• 3M AM-PPCs logic is the same for every user, although different users may choose not to report certain 3M AM-PPCs. Each user makes its own decisions about appropriate use, including risk adjustment and comparison of individual hospital performance with an appropriate benchmark.
• 3M AM-PPCs are integrated with other 3M patient classification methodologies. 3M AM-PPCs can be identified from certain inpatient claims using the 3M™ All Patient Refined DRG (APR DRG) software. 3M APR DRGs are used in identifying complications of care for inpatient claims that contain an ambulatory procedure performed prior to admission. This is relevant for inpatient claims subject to the three-day payment rule or 72-hour payment rule.

3M AM-PPCs are available in the following 3M products: 
 

• 3M™ Core Grouping Software (CGS)

Available to software licensees on the 3M customer support website
 

• 3M AM-PPCs Definitions Manual
• 3M AM-PPCs Summary of Clinical Logic Updates
• 3M AM-PPCs Norm Files (Microsoft Excel File)

• The unit of analysis is an ambulatory encounter in which an elective procedure is performed and may be followed by a complication of care within subsequent hospital admissions, emergency department visits or other ambulatory encounters. All the data required to do a 3M AM-PPC analysis can be obtained from a standard outpatient, professional or inpatient hospital/provider claim, such as the UB-04 form or the X12N, 837I, 837P electronic transaction.
• Individual records must be linked using consistent identifiers for both the patient and the hospital/provider. Data fields that are particularly important include claim bill type or place or service, all diagnosis codes, present on admission (POA) indicators for inpatient claims, ICD-10-PCS procedure codes, procedure code dates, line-item HCPCS/CPT® procedure codes with service dates, line-item revenue codes to identify ED visits (045x). Because it is important whether a diagnosis was present on admission for inpatient admissions, 3M recommends that any 3M AM-PPC analysis include an evaluation of the likely accuracy of POA indicators. Suggested criteria are available on the 3M customer support website.

• Despite advancements in modern hospital care, quality problems remain, impacting patient outcomes and provider costs. In the early 2000s, 3M assembled a team to develop a methodology that could identify situations in which inpatient hospital care was less than excellent. The resulting methodology, inpatient 3M™ Potentially Preventable Complications Grouping Software (PPCs), was first published in the Health Care Financing Review in 2006. Since then, the methodology has been regularly updated and increasingly adopted across the U.S. The implementation and success of inpatient PPCs have allowed for 3M to shift its focus to assess the quality of outpatient care. In 2015, 3M researchers reassembled a team to develop 3M AM-PPCs, a methodology that could evaluate ambulatory procedures that resulted in complications of care within a longitudinal analysis using a designated timing window (e.g., 30 days).
• The 3M AM-PPCs applies sophisticated clinical logic to identify more than 2,900 procedures and clinically categorize them within 93 distinct procedure subgroups (PSGs). PSGs are comprised of common elective procedures often performed in outpatient care settings. There are 35 potentially preventable complication groups, which include more than 1,200 complications such as: sepsis, pneumonia and lung infections, pulmonary embolism, venous thrombosis, hemorrhage and hematoma and device related infections or mechanical complications.
• Potentially preventable complications are identified by the 3M AM-PPC software by linking an ambulatory procedure to a subsequent admission, emergency department visit, or other ambulatory encounter reporting a complication diagnosis code, in timeline sequence and matching a predefined procedure-specific complication list and timing guidelines. Complications that are not related to the initial procedure or that present prior to the date in which they are expected to occur are excluded by the 3M AM-PPC logic.

The 3M AM-PPCs are identified through diagnosis and procedure codes listed on standard claim forms. The 3M proprietary clinical logic is maintained by a team of 3M clinicians, data analysts, nosologists, programmers and economists and can be viewed by software licensees in an online definition’s manual. 3M plans to release a new 3M AM-PPCs version every Oct. 1, to reflect updates in the ICD-10 diagnosis and procedure code sets and to include enhancements in the clinical classification logic.