The Oklahoma Health Care Authority (OHCA) will use 3M’s Potentially Preventable Readmissions (PPR) methodology for the evaluation and comparison of readmissions rates by hospital. OHCA will reduce payment rates to hospitals determined to have higher rates of readmissions, after applying the PPR method’s risk adjustment.
The PPR methodology has been used by Medicaid programs in several states, including Texas, Illinois, New York and Massachusetts and OHCA believes it will also be the best basis for the SoonerCare PPR program. As an example, Texas Medicaid applies a 1 percent payment reduction to hospitals with an actual-to-expected PPR ratio between 1.11 and 1.25, and a 2 percent reduction to hospitals with a ratio over 1.25, with an exemption for very small hospitals with few cases.
OHCA is in the process of reviewing hospital specific data and has not yet finalized the details of the program. As soon as there are updates, OHCA will begin corresponding with individual hospitals.
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