APR DRG Data Discovery
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1 APR DRG Data Discovery Henry Johnson MD, MPH Midas+ Vice President and Medical Director Vanessa Dorr RN MSN Midas+ DataVision Clinical Consultant
2 Review: Agenda 3M APR DRG Methodology DataVision: Web and Server Applications Data Discovery: Resource use and Length of Stay: Wren Memorial, Cardiac Services Michael Memorial Orthopedic Services Mortality Vitale Memorial Hospital, Percutaneous Coronary Intervention (PCI) Summary and Questions 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 2
3 Severity Adjustment Systems All Patient Diagnostic Related Group (AP DRG) 1987: New York passed prospective payment for all non-medicare patients All-Payer Severity-adjusted DRG (APS DRG) Different methodology, also developed from the DRG model All Patient Refined DRG (APR DRG) Researched and developed by New York Department of Health (NYDH) in partnership with 3M Health Information Systems (HIS) Others: STS, APACHE, Disease Staging, MedisGroups 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona
4 3M APR DRG Expanded the scope of DRGs to add: Severity of Illness (SOI) The extent of physiologic decompensation or organ system loss of function Risk of Mortality (ROM) The likelihood of dying 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona
5 Development Process: Clinically Coherent with Sufficient Case Volume Start with All Patient DRGs (AP DRGs) Consolidate Combine the with CC and without CC DRGs Each APR DRG has a four-point CC scale built in Pediatric additions Add APR DRGs for mortality Eliminate any unique DRGs for deaths only 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona
6 Subclass Assignment Assign each secondary diagnosis a SOI and ROM level (subclass) from 1 to 4 In an iterative fashion, assign a subclass number based on dominant secondary diagnoses Some modifications for age Hypertension in children is considered major as a secondary Some modifications for specific APR DRGs Chronic Renal Failure as a secondary is Moderate, except if the APR DRG is diabetes, in which case it is Major 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona
7 Testing After the clinical model for SOI and ROM is developed for each base APR DRG, it is evaluated with historical data to be sure the subclasses predict resource use (SOI) and mortality rate (ROM). Version 20.0 was evaluated with a national database of 8.5 million discharges, all payers, from 1,000 hospitals from 10 states, and 47 children s hospitals in the U.S. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona
8 Beginning with APR DRG v.20 For each APR DRG subclass, a Relative Weight (RW) was calculated to reflect the resources required for a patient in that APR DRG subclass. The subclass RW allows calculation of an overall Case Mix Index (CMI) for the hospital or by physician or physician group, which is severityadjusted. Allows for more refined reimbursement 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona
9 APR DRG v20: Relative Weights Base Rate RW Payment $ 4, $ 2, $ 4, $ 3, $ 4, $ 5, $ 4, $ 12, st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona
10 Cautions APR DRG SOI and ROM subclasses are ranked categories unique to each APR DRG and cannot be averaged across APR DRGs (they are not really numbers). For example, congestive heart failure patients in severity subclass 4 are not comparable to patients with a fractured leg in severity subclass 4. In version 20.0 or later, you can average the RW. Beware choosing a population by MS-DRG or ICD-9 diagnosis and running reports or doing analysis for the whole population by APR DRG SOI or ROM. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona
11 DataVision Architecture Midas+ Care Management Standardized Measures: DataVision Navigator National Comparisons: DataVision Web Application Hospital Server Midas+ Solutions: Tucson AZ 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 11
12 DataVision APR DRG Reports 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 12
13 APR DRG Reports APR-DRG Lives/Days Saved Report Compares the facility's mortality and average length of stay (ALOS) data observed/expected (O/E) ratio statistics with the Midas+ comparative database (CDB) mean Provides site percentile rank in comparison with the CDB Predicts the number of lives and days that might be saved if outcomes improved to a different percentile Hospital APR-DRG Service Line Profile Lists all 3M APR DRG defined service lines for the facility Provides mortality, ALOS, and Potentially Preventable Readmission (PPR) O/E ratio or delta statistics based on the CDB mean 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 13
14 APR DRG Reports Hospital APR-DRG Ranking Profile Lists all APR DRGs and provides mortality, ALOS, and Potentially Preventable Readmission (PPR) O/E ratio or delta statistics based on the CDB mean APR-DRG Comparative Trend Analysis A two-part report that displays the length of stay O/E ratio and the mortality O/E ratio for the selected APR DRG, comparing the facility s performance with percentiles from the CDB 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 14
15 APR-DRG Subclass Detail APR DRG Reports A three-part report that examines facility LOS for the APR DRG, stratified by four severity-of-illness (SOI) levels Mortality rates for the APR DRG, stratified by four ROM levels Potentially Preventable Readmissions, stratified by four SOI levels This report includes percentile comparisons with the comparative database Single APR-DRG Comparison Profile Lists all providers for a specific APR DRG and provides mortality and ALOS statistics for each provider Can be viewed by provider name or code Parameter allows report to be viewed by attending or principal procedure provider 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 15
16 APR DRG Reports APR-DRG Specialty Comparison Report Compares a single provider to her peers for LOS and mortality, within the hospital and with the comparative database Based on mapping of specialty groups specialties with admitting or attending activity Provider APR-DRG Detail Report Lists all APR DRGs for a selected provider and provides mortality and LOS statistics for each APR DRG as well as a specialty comparison All APR-DRG Provider Summary Observed and expected mortality and LOS data for each of the facility s providers This report is useful for identifying high-volume providers 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 16
17 What Is New on Your Server? What is in the ToolPack? 256 fields... 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 17
18 Description # fields Patient Demographics 14 Encounter description, including LOS 15 Admitting/Attending Physician 8 Discharging Physician 3 Payer, charge, and cost data 6 DRG (CMS) related 10 Principal Diagnosis 3 Principal Procedure 5 Count of Diagnoses, Count of Not Present on Admission 2 Secondary Diagnoses (total 25 possible, including principal) 72 Secondary Procedures (total 20 possible, including principal) 95 Consultants (total 5) 10 Primary Care physician 2 APR DRG-related 10 Birthdate 1 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 18
19 New fields in Excel Toolpack Export APR DRG 174 APR DRG DESC APR DRG Severity 2 APR DRG Mortality Risk 2 APR DRG MDC 5 CDB APR DRG All Inpatient Expected 2.9 CDB APR DRG All Inpatient Expected 0.41% Mortality CDB APR DRG Acute Care Expected 2.9 CDB APR DRG Acute Care Expected 0.41% Mortality Percutaneous cardiovascular procedures w AMI 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 19
20 Steps to Data Discovery 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 20
21 Resource Use and Length of Stay: Wren Memorial, Cardiac Services Question: What determines LOS? Discharge planning Events that prolong stay Why is looking at long LOS important? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 21
22 Basic Steps: Start with DataVision web application: SmartReport APR-DRG Reports Next, move to server for patient data Report Toolpack 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 22
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33 Total of 1,214.3 days, or 3.3 beds/day if we can go to the mean. Can we do better? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 33
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36 Wren March 2011 to February 2012 APR DRG Code Description # Cases Obs ALOS Expec ted LOS Ratio Perce ntile Rank 20th Percentile Pred ALOS Days saved # hospitals 194 Heart failure th Cardiac arrhythmia & conduction disorders Percutaneous cardiovascular procedures w/o AMI nd nd Acute myocardial infarction rd Percutaneous cardiovascular procedures w AMI th If we can perform better than 80% of the hospitals in the comparative database, for these five APR-DRGs in the cardiac service line, we will save 3,231 bed days, or almost 9 extra beds/day more room for transferring ICU patients and decreasing waits in the Emergency Department. 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 36
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40 To the Server: Midas+ Care Management Standardized Measures: DataVision Navigator National Comparisons: DataVision Web Application Hospital Server Midas+ Solutions: Tucson AZ 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 40
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46 Wren APR DRG 194 Heart Failure 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 46
47 Wren APR DRG 174 PCI w AMI 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 47
48 Wren APR DRG 175 PCI w/o AMI 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 48
49 Wren APR DRG 190 AMI 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 49
50 Wren APR DRG 201 Card Arrhy Condn Disords 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 50
51 Steps to Data Discovery Web application: reviewed SmartReport Hospital APR-DRG Ranking Profile Set parameters to Days Delta Take contents to Excel to view and rank Hospital APR-DRG Service Line Profile Drill down to a service line Days Saved Report bring out to Excel Estimate total Days Saved at 20 th percentile Check by Attending and Principal Procedure Provider To server: build APR Indicators Run Toolpacks 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 51
52 Resource Use and Length of Stay: Michael Memorial, Orthopedics 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 52
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61 To the Server: Midas+ Care Management Standardized Measures: DataVision Navigator National Comparisons: DataVision Web Application Hospital Server Midas+ Solutions: Tucson AZ 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 61
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64 Michael Mem APR DRG 301 Total Hip Repl Christopher APR DRG 301 Total Hip Repl 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 64
65 Steps to Data Discovery Web application: review SmartReport APR-DRG Service Line Profile Set parameters to Days Delta Review APR-DRG Choose APR-DRG that is easily actionable Look at AP-DRG 301, Total Hips To server: build APR Indicators Run Toolpack 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 65
66 Mortality: Vitale Memorial Percutaneous Coronary Intervention Consider: Does the hospital have a hospice unit? Recall that on the DataVision web application Acute Care is All Patients, excluding» Obstetrics» Rehabilitation» Behavioral Health» Hospice Does the hospital use code V66.7 Palliative Care? 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 66
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88 To the Server: Midas+ Care Management Standardized Measures: DataVision Navigator National Comparisons: DataVision Web Application Hospital Server Midas+ Solutions: Tucson AZ 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 88
89 Vitale APR DRG 174 PCI w AMI 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 89
90 Steps to Data Discovery Review SmartReport, find high mortality rate Run Comparative Trend Analysis APR-DRG Ranking Profile Facility/Mortality Data Hospice present Review SmartReport Facility/Mortality Data: No hospice Lives/Days Saved Report: APR 174 Remove V66.7 coded patients View CTA and subclass detail Profile by Doctor To server: build Indicator, run ToolPack 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona 90
91 Questions: 21st Annual Midas+ User Symposium May 20 23, 2012 Tucson, Arizona
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