State of Florida: Patients Admitted with APR DRG 194 Heart Failure Reasons for Readmission
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1 Patients Readmitted within 15 days pril arch 2008 F+H++ B C D E F G H # of % of Total Patients Readmitted % of % of % of % of Heart Failure 2, % 2, % % 1, % % Renal Failure % % % % % Pulmonary Edema & Respiratory Failure % % % % % Chronic Obstructive Pulmonary Disease % % % % % Septicemia & Disseminated nfections % % % % % Cardiac rrhythmia & Conduction Disorders % % % % 5 0.9% cute yocardial nfarction % % % % % Other Pneumonia % % % % % Cardiac Catheterization with Circulatory Disorder Except schemic Heart Disease % % % % 3 0.5% ngina Pectoris & Coronary therosclerosis % % % % % Other Circulatory System Diagnoses % % % % 7 1.2% ajor Respiratory nfections & nflammations % % % % 7 1.2% idney & Urinary Tract nfections % % % % 5 0.9% CV & Precerebral Occlusion with nfarct % % % % 5 0.9% Diabetes % % % % 4 0.7% Other & Unspecified Gastrointestinal Hemorrhage % % % % 3 0.5% Hypovolemia & Related Electrolyte Disorders % % % % 2 0.3% Other idney & Urinary Tract Diagnoses, Signs & Symptoms % % % % 2 0.3% Syncope & Collapse % % % % 2 0.3% Electrolyte Disorders Except Hypovolemia Related % % 2 0.1% % 3 0.5% ajor Gastrointestinal & Peritoneal nfections % % % % 3 0.5% Other Digestive System Diagnoses % % % % 2 0.3% Peptic Ulcer & Gastritis % % 7 0.5% % 3 0.5% Respiratory System Diagnosis with Ventilator Support 96+ Hours % % % % 3 0.5% Cardiac Catheterization for schemic Heart Disease % % 6 0.4% % 2 0.3% Cellulitis & Other Bacterial Skin nfections % % % % 3 0.5% Respiratory System Signs, Symptoms & Other Diagnoses % % 9 0.6% % 0 0.0% Chest Pain % % 9 0.6% % 1 0.2% Other nemia & Disorders of Blood & Blood Forming Organs % % 6 0.4% % 3 0.5% ajor Depressive Disorders & Other/Unspecified Psychoses % % 4 0.3% 9 0.3% % Peripheral & Other Vascular Disorders % % % % 3 0.5% Pulmonary Embolism % % 3 0.2% % 1 0.2% Nontraumatic Stupor & Coma % % 8 0.5% 5 0.2% 2 0.3% Cardiomyopathy % % 1 0.1% 8 0.2% % Transient schemia % % 9 0.6% % 1 0.2% Diverticulitis & Diverticulosis % % 7 0.5% % 0 0.0% alfunction, Reaction & Comp of Cardiac or Vasc Device or Proc % % 7 0.5% % 0 0.0% Non-Bacterial Gastroenteritis, Nausea & Vomiting % % 8 0.5% % 0 0.0% Other Respiratory Diagnosis Except Signs, Symptoms & inor Diagnoses % % 7 0.5% 8 0.2% 5 0.9% Other Disorders of Nervous System % % 2 0.1% 9 0.3% 7 1.2% Other usculoskeletal System & Connective Tissue Diagnoses % % 7 0.5% % 2 0.3% Printed: 5/1/2009 Page 1 of 3
2 Patients Readmitted within 15 days pril arch 2008 F+H++ B C D E F G H # of % of Total Patients Readmitted % of % of % of % of Poisoning of edicinal gents % % 6 0.4% % 1 0.2% bdominal Pain % % 6 0.4% % 1 0.2% nterstitial ung Disease % % 9 0.6% 5 0.2% 2 0.3% ntestinal Obstruction % % 5 0.3% % 0 0.0% Seizure % % 6 0.4% 6 0.2% 0 0.0% Cardiac Congenital & Valvular Disorders % % 3 0.2% 9 0.3% 1 0.2% Disorders of Pancreas Except alignancy % % 4 0.3% % 0 0.0% Organic ental Health Disturbances % % 1 0.1% 0 0.0% % Tracheostomy with -T ech. Ventilation without Extensive Procedure % % 2 0.1% 6 0.2% 0 0.0% Disorders of the Gallbladder & Biliary Tract % % 4 0.3% 8 0.2% 0 0.0% Degenerative Nervous System Disorders Exc ult Sclerosis % % 2 0.1% 3 0.1% 5 0.9% Other Esophageal Disorders % % 4 0.3% 3 0.1% 1 0.2% Peripheral, Cranial & utonomic Nerve Disorders % % 4 0.3% 8 0.2% 0 0.0% Post-Operative, Post-Traumatic, Other Device nfections % % 7 0.5% 3 0.1% 0 0.0% Skin Ulcers % % 5 0.3% 4 0.1% 2 0.3% Hypertension % % 2 0.1% % 0 0.0% Other Back & Neck Disorders, Fractures & njuries % % 3 0.2% 5 0.2% 2 0.3% Schizophrenia % % 1 0.1% 3 0.1% 7 1.2% sthma % % 1 0.1% 9 0.3% 0 0.0% Cardiac rrest % % 1 0.1% 4 0.1% 0 0.0% Hepatic Coma & Other ajor cute iver Disorders % % 3 0.2% 3 0.1% 1 0.2% Other Complications of Treatment % % 1 0.1% 6 0.2% 0 0.0% cute & Subacute Endocarditis 8 0.1% % 1 0.1% 4 0.1% 0 0.0% Bipolar Disorders 8 0.1% % 0 0.0% 0 0.0% 7 1.2% Gastrointestinal Vascular nsufficiency 8 0.1% % 1 0.1% 5 0.2% 1 0.2% HV with ajor HV Related Condition 8 0.1% % 0 0.0% 7 0.2% 0 0.0% ntracranial Hemorrhage 8 0.1% % 1 0.1% 3 0.1% 3 0.5% alnutrition, Failure To Thrive & Other Nutritional Disorders 8 0.1% % 2 0.1% 1 0.0% 2 0.3% Other Endocrine Disorders 8 0.1% % 2 0.1% 3 0.1% 1 0.2% ale Reproductive System Diagnoses Except alignancy 7 0.1% % 2 0.1% 5 0.2% 0 0.0% Other Disorders of The iver 7 0.1% % 1 0.1% 2 0.1% 2 0.3% Other Ear, Nose, outh,throat & Cranial/Facial Diagnoses 7 0.1% % 2 0.1% 2 0.1% 0 0.0% Other nfectious & Parasitic Diseases 7 0.1% % 0 0.0% 3 0.1% 0 0.0% Coagulation & Platelet Disorders 6 0.1% % 0 0.0% 3 0.1% 1 0.2% Fever 6 0.1% % 2 0.1% 4 0.1% 0 0.0% cute nxiety & Delirium States 5 0.1% % 1 0.1% 3 0.1% 1 0.2% Connective Tissue Disorders 5 0.1% % 0 0.0% 5 0.2% 0 0.0% ajor Esophageal Disorders 5 0.1% % 1 0.1% 2 0.1% 1 0.2% Nonspecific CV & Precerebral Occlusion without nfarct 5 0.1% % 0 0.0% 5 0.2% 0 0.0% Vertigo & Other abyrinth Disorders 5 0.1% % 1 0.1% 4 0.1% 0 0.0% lcohol buse & Dependence 4 0.1% % 0 0.0% 4 0.1% 0 0.0% Printed: 5/1/2009 Page 2 of 3
3 Patients Readmitted within 15 days pril arch 2008 F+H++ B C D E F G H # of % of Total Patients Readmitted % of % of % of % of lcoholic iver Disease 4 0.1% % 0 0.0% 3 0.1% 0 0.0% llergic Reactions 4 0.1% % 1 0.1% 3 0.1% 0 0.0% Female Reproductive System nfections 4 0.1% % 0 0.0% 1 0.0% 0 0.0% ajor Hematologic/mmunologic Diag Exc Sickle Cell Crisis & Coagul 4 0.1% % 1 0.1% 2 0.1% 0 0.0% Other njury, Poisoning & Toxic Effect Diagnoses 4 0.1% % 3 0.2% 0 0.0% 1 0.2% djustment Disorders & Neuroses Except Depressive Diagnoses 3 0.0% % 1 0.1% 1 0.0% 1 0.2% HV with ultiple ajor HV Related Conditions 3 0.0% % 1 0.1% 1 0.0% 1 0.2% Other Drug buse & Dependence 3 0.0% % 1 0.1% 2 0.1% 0 0.0% Other Skin, Subcutaneous Tissue & Breast Disorders 3 0.0% % 1 0.1% 2 0.1% 0 0.0% Toxic Effects of Non-edicinal Substances 3 0.0% % 0 0.0% 3 0.1% 0 0.0% Bacterial & Tuberculous nfections of Nervous System 2 0.0% % 0 0.0% 1 0.0% 1 0.2% Cocaine buse & Dependence 2 0.0% % 0 0.0% 1 0.0% 1 0.2% Depression Except ajor Depressive Disorder 2 0.0% % 1 0.1% 1 0.0% 0 0.0% HV with ultiple Significant HV Related Conditions 2 0.0% % 0 0.0% 2 0.1% 0 0.0% Osteomyelitis, Septic rthritis & Other usculoskeletal nfections 2 0.0% % 1 0.1% 1 0.0% 0 0.0% Other ental Health Disorders 2 0.0% % 0 0.0% 1 0.0% 1 0.2% HV with One Signif HV Cond or without Significant Related Conditions 1 0.0% % 0 0.0% 1 0.0% 0 0.0% nfections of The Upper Respiratory Tract 1 0.0% % 1 0.1% 0 0.0% 0 0.0% nflammatory Bowel Disease 1 0.0% % 1 0.1% 0 0.0% 0 0.0% ajor Skin Disorders 1 0.0% % 0 0.0% 1 0.0% 0 0.0% igraine & Other Headaches 1 0.0% % 0 0.0% 1 0.0% 0 0.0% Opioid buse & Dependence 1 0.0% % 0 0.0% 0 0.0% 1 0.2% Urinary Stones & cquired Upper Urinary Tract Obstruction 1 0.0% % 1 0.1% 0 0.0% 0 0.0% Viral llness 1 0.0% % 1 0.1% 0 0.0% 0 0.0% Total 6, % 5, , % 1, % 3, % % Printed: 5/1/2009 Page 3 of 3
4 Patients Readmitted within 15 days pril arch 2008 H++Q+ N B ++O+R C D B/ E F G H N O P Q R S # of % Readmitted Patients # of to nother Readmission Patients Readmitted dmitted Patients Hospital Rate dmitted Readmitted Charges dmitted Readmitted Charges dmitted Readmitted Charges dmitted Readmitted Charges ll Others 1, % 11.8% $3,788,925 $707,402 $1,246, $389, $710,201 1, $3,847, $795,138 Commercial HO 1, % 11.0% $4,669,752 $1,492,020 $627, $1,074, $1,308,629 1, $4,156, $249,323 Commercial nsurance % 11.4% $2,402,772 $659,159 $194, $360, $350, $2,400, $145,305 Commercial PPO 1, % 8.7% $3,748,869 $1,066,116 $700, $222, $855,516 1, $4,294, $142,890 edicaid 2, % 15.4% $10,964,568 $4,406,250 $5,496, $1,519, $2,789,745 2, $15,958, $599,722 edicare 39,624 5, % 13.7% $138,277,409 $49,101,402 $32,204,694 7,038 1,210 $55,704,759 9,016 1,392 $60,425,597 20,810 2,314 $91,090,095 2, $12,363,054 Self Pay/Underinsured 1, % 9.4% $3,078,626 $1,556,904 $1,526, $80, $552,186 1, $5,455, $74,337 Total 49,632 6, % 13.3% $166,930,921 $58,989,253 $41,996,519 7,420 1,284 $59,351,862 9,941 1,531 $66,992,283 29,101 3,208 $127,202,779 3, $14,369,769 Printed: 5/1/2009 Page 1 of 1
5 Patients Readmitted within 15 days pril arch 2008 H++Q+ N B E+F+G or ++O+R C D B/ E F G H /H / N O P O/N Q R S R/Q Total Patients Patients to nother Readmission Patients Readmitted dmitted Readmitted Hospital Rate dmitted Readmitted Rate dmitted Readmitted Rate dmitted Readmitted Rate dmitted Readmitted Rate ll Others 1, % 11.8% % % 1, % % Commercial HO 1, % 11.0% % % 1, % % Commercial nsurance % 11.4% % % % % Commercial PPO 1, % 8.7% % % 1, % % edicaid 2, % 15.4% % % 2, % % edicare 39,624 5, % 13.7% 4, ,038 1, % 9,016 1, % 20,810 2, % 2, % Self Pay/Underinsured 1, % 9.4% % % 1, % % Total 49,632 6, % 13.3% 5, ,420 1, % 9,941 1, % 29,101 3, % 3, % Without ental Health ssue Patients Patients to nother Readmission Patients Readmitted dmitted Readmitted Hospital Rate dmitted Readmitted Rate dmitted Readmitted Rate dmitted Readmitted Rate dmitted Readmitted Rate ll Others 1, % 11.5% % % 1, % % Commercial HO 1, % 10.8% % % 1, % % Commercial nsurance % 10.9% % % % % Commercial PPO 1, % 8.7% % % 1, % % edicaid 2, % 15.5% % % 2, % % edicare 38,242 5, % 13.5% 4, ,647 1, % 8,726 1, % 20,283 2, % 2, % Self Pay/Underinsured 1, % 9.5% % % 1, % % Total 47,650 6, % 13.1% 5, ,995 1, % 9,602 1, % 28,108 3, % 2, % With ental Health ssue Patients Patients to nother Readmission Patients Readmitted dmitted Readmitted Hospital Rate dmitted Readmitted Rate dmitted Readmitted Rate dmitted Readmitted Rate dmitted Readmitted Rate ll Others % 15.7% % % % % Commercial HO % 16.9% % % % % Commercial nsurance % 22.9% % % % % Commercial PPO % 8.2% % % % % edicaid % 15.1% % % % % edicare 1, % 19.0% % % % % Self Pay/Underinsured % 6.9% % % % % Total 1, % 17.4% % % % % Printed: 5/1/2009 Page 1 of 1
State of Florida: Patients Admitted with APR DRG 139 Other Pneumonia. Reasons for Readmission
Patients Readmitted within 15 days pril 2007 - arch 2008 F+H++ B C D E F G H # of % of Total Patients Readmitted % of % of % of % of Other Pneumonia 589 18.5% 507 66 16 88 12.0% 81 15.0% 333 21.1% 87 26.8%
APR-DRG Description Ave Charge
Abdominal Pain 16,500.25 2.8 6,000.09 Acute & Subacute Endocarditis 15,339.30 3.0 5,113.10 Acute Myocardial Infarction 17,687.46 2.6 6,802.87 Alcohol Abuse & Dependence 19,126.64 4.2 4,553.96 Alcoholic
DRG Code DRG Description FY18 Average Charge
DRG Code DRG Description FY18 Average Charge 3 ECMO OR TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O $ 665,511 4 TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $ 422,497 37 EXTRACRANIAL
All Medicaid (APR) DRG 2015
All Medicaid (APR) DRG 2015 DRG DRG Description Avg. Charge 251 Abdominal Pain $9,517.49 564 Abortion w/o D&C, Aspiration Curettage or Hysterotomy $8,133.15 193 Acute & Subacute Endocarditis $13,780.84
Randolph Health Average Inpatient DRG Charge
004 Trach W Mv >96 Hrs Or Pdx Exc Face, Mouth & Neck W/O Maj O.R. 244,470 040 Periph/Cranial Nerve & Other Nerv Syst Proc W Mcc 61,412 041 Periph/Cranial Nerve & Other Nerv Syst Proc W Cc Or Periph Neurostim
Average Gross Charges ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC ,254 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC - 280
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC - 281 15,254 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC - 280 24,827 ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC - 282 11,575 AFTERCARE,
SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC 84, ,037.80
Inpatient Visits by DRG Inpatient Discharges between 10/01/17 and 09/30/18 DRG DRG Description Average Charge Self-Pay Price VAGINAL DELIVERY W/O COMPLICATING 775 DIAGNOSES 14,680.67 5,578.66 795 NORMAL
Maine Workers' Compensation Board Medical Fee Schedule
001 SURG HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC 29.1 26.4106 $243,431.25 $257,869.40 002 SURG SYSTEM W/O MCC 15.1 13.4227 $123,719.44 $131,057.36 003 SURG MOUTH & NECK W MAJ O.R. 23.4
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APC/DRG Code APC/DRG Name # of Discharges Average of Charges 5341 Abdominal/Peritoneal/Biliary and Related Procedures 71 $9, ACUTE ADJUSTMENT
5341 Abdominal/Peritoneal/Biliary and Related Procedures 71 $9,950 880 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION MS 3 $8,161 62 ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W CC MS 10 $30,145
004 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $134, TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC $27,845.
DRG Number DRG Name DRG Average Charge 004 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $134,495.54 011 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC $27,845.14 012 TRACHEOSTOMY FOR
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DRG DRG DESCRIPTION AVE CHARGE AVE DAYS 4 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $176, TRACHEOSTOMY FOR
DRG DRG DESCRIPTION AVE CHARGE AVE DAYS 4 TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. $176,341.00 13.0 11 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC $82,442.00 11.0 25 CRANIOTOMY
1 640 Normal Newborn, Birthweight 2500g+ $3,741 $2,245 $ Vaginal Delivery $9,133 $5,480 $2,192
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770 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY $27, ABORTION W/O D&C $17, ACUTE & SUBACUTE ENDOCARDITIS W CC $34,537.
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