The Right Moves for Success with Medicare - Additional Exhibits
An hfm Web Exclusive
A hospital examined the frequency of MS-DRG 871 Septicemia w/o MV 96+ with MCC in comparison with MS-DRG 872 w/o MCC. This facility has improved the capture of the MCC since implementation of MS-DRGs, but has not yet reached a targeted goal of 80th percentile performance.
Exhibits 2 and 3
A comparison of one hospital's performance against its state peer group shows this facility's heart failure patients have a lower distribution of severity than the state performance. Of the total volume, many cases are categorized in severity subclasses 1 and 2 showing lower complexity. The facility should determine if lack of specificity in coding or lack of physician documentation is causing lower severity scores or if in fact the facility's patient population is of lower complexity.
A facility's mortality is compared with its state peer group to determine expected deaths against actual mortality. This facility has more deaths than expected, with a significant variance in subclass 2 and 3. (Scale is 1 minor, 2 major, 3 moderate, 4 extreme expectation of death.)
An evaluation of LOS reveals that this hospital has exceeded peer group severity-adjusted LOS in each APR DRG subclass. An audit should be conducted of individual cases above the severity-adjusted LOS to determine if systemic documentation issues are causing the variances.
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Publication Date: Sunday, June 01, 2008