HIM220 Assignment Chap 14 PDF

Preview

Summary

Download HIM220 Assignment Chap 14 PDF

Description

Chapter 14 Healthcare Statistics Marjorie H. McNeill, PhD, RHIA, CCS, FAHIMA

Real-World Case 14.1 The performance improvement committee of Community Regional Medical Center wanted to study MS-DRG 689 kidney and urinary tract infections with MCC (major complication or comorbidity) because of wide variations in length of stay (LOS) and total charges (refer to chapter 15, Revenue Management and Reimbursement, for more information on MS-DRGs and MCCs). The committee asked the HIM director to prepare a profile of patients discharged from MS-DRG 689. A summary of the patients discharged from MS-DRG 689 at Community Hospital was prepared using information found in the hospital’s online database. Further research was performed on the individual patient records to determine if there was a correlation between the LOS and the MCCs for the patients. A summary of the patients discharged from MS-DRG 689 at Community Hospital is presented in the table below. Data for Real-World Case 14.1 discussion Case

Principal Diagnosis

Principal Procedure

Age

LOS

Discharge Destination

Charges

Payer

1

599.0

38.93

4

HOMEIV

2

599.0

45.13

7

HOMEHEALTH

3

590.8

3

HOME

$4,370 MANAGED CARE

4

590.8

3

HOMEHEALTH

$7,121 GOV MNGD CARE

5

590.8

3

HOME

$13,350 MEDICAID

6

590.8

45.23

4

HOME

$15,854 MANAGED CARE

7

599.0

39.95

6

SNF

$22,373 MEDICARE

8

599.0

6

HOMEHEALTH

$11,381 GOV MNGD CARE

9

590.1

2

HOME

10

599.0

6

HOMEHEALTH

11

590.8

3

HOME

12

599.0

5

HOMEHEALTH

86.27

43.11

$8,851 MEDICAID $18,966 MEDICARE

$4,082 MEDICAID $17,025 MEDICARE $5,039 MEDICAID $17,411 MEDICARE

1 Copyright ©2020 by the American Health Information Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, photocopying, recording or otherwise without prior permission from the publisher.

13

599.0

99.6

1

UNKNOWN

14

599.0

88.72

4

HOME

$11,091 MEDICARE

15

599.0

SNF

$23,341 MEDICARE

16

590.8

4

HOMEHEALTH

$16,277 MEDICARE

17

599.0

5

HOMEHEALTH

$9,239 MEDICARE

18

599.0

7

SNF

19

590.1

4

HOME

20

590.8

21

599.0

22

599.0

23

599.0

24

599.0

25

12 45.16

38.93

13

ACUTECARE

$5,302 MEDICARE

$21,050 MEDICARE $7,085 GOV MNGD CARE $49,487 MEDICAID

2

HOMEHEALTH

5

SNF

$11,651 MEDICARE

5

SNF

$12,295 MEDICARE

7

HOMEHEALTH

$23,745 MEDICARE

599.0

10

HOMEHEALTH

$25,130 MEDICARE

26

599.0

3

SNF

$10,092 MEDICARE

27

599.0

3

HOMEIV

$8,722 MEDICAID

28

599.0

2

SNF

$6,670 MEDICAID

29

599.0

8

SNF

$17,741 GOV MNGD CARE

30

590.1

4

HOME

$10,800 MANAGED CARE

31

590.8

2

HOME

$10,916 MEDICAID

32

599.0

8

SNF

$32,796 MEDICARE

86.27

99.04

38.93

45.13

45.13

$8,980 MEDICARE

1. Calculate the length of stay for all patients. Average: 161/32= 5.03 days 2. Calculate the average length of stay for Medicare patients. Average: 97/17= 5/71 days 3. Calculate the average charge for all patients. Average: $468,233/32= $14,632.28 4. Calculate the average charge for Medicaid patients. Average= $107,117/8 = $13,389.63 2 Copyright ©2020 by the American Health Information Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, photocopying, recording or otherwise without prior permission from the publisher.

5. Calculate the average age of all patients. Average: 1946.7/32 = 60.83 6. Calculate the average age of patients discharged to skilled nursing facilities. Average: 689.3/9 = 76.59 7. Calculate the average age of patients discharged home. Average: 420.9/9 = 46.77 8. Calculate the ratio of Medicare patients to Medicaid patients Medicaid=8 Medicare=17 17:8

Real-World Case 14.2 University Hospital is preparing for an upcoming onsite survey with the Joint Commission. With an expanded focus on patient safety, the Joint Commission has identified infection prevention as a focal area in the survey process. Surveyors will specifically target prevention strategies and outcomes during reviews of the hospitals infection control policies and procedures since infections can lead to serious complications, longer patient stays, and death. A low infection rate can be an indicator of quality care. University Hospital has determined that the infection rate for each physician should be 1 percent or lower. MS-DRG Description Heart Transplant or Implant of Health 2 Assist System w/o MCC Cardiac Valve & Other Maj 216 Cardiothoracic Proc w Card Cath w MCC Coronary Artery Bypass w PTCA w/o 232 MCC 237 Major Cardiovas proc w MCC

Relative Wt.

National LOS

15.6820

15.7

9.2380

13.0

5.5976

7.9

5.0843

6.7

Complete the information below to determine the case mix of these surgery patients in your facility.

DRG

Your hospital's Actual LOS

2 216 232 237

20.9 12.1 7.1 11.6

Number of Patients (estimate)

3 107 240 156

Your hospital’s average charges $89,500 $49,500 $32,000 $25,000

3 Copyright ©2020 by the American Health Information Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, photocopying, recording or otherwise without prior permission from the publisher.

1.

Determine the case mix for the following group of procedures:

MS-DRG 2 216 232 237 Totals Case mix

Number of Patients 3 107 240 156

Total Weights 47.05 988.47 1,343.42 793.15

3172.09/506

6.27

2. Calculate the estimated per patient payment from third parties for these MS-DRGs. Round to a whole number.

MS-DRG 2 216 232 237

3.

4.

Your hospital's actual average charge $89,500 $49,500 $32,000 $25,000

Calculate the difference in LOS:

MS-DRG 2 216 232 237

Estimated per patient revenue Number of patients from third parties (based on a (estimate) hospital payment rate of $5,500) 3 15.68x5,500 = 86,251 107 9.24x5,500= 50,809 240 5.60x5,500 = 30,787 156 5.08x5,500 = 27,964

Your hospital's Actual LOS 20.9 12.1 7.1 11.6

National Average LOS Difference 5.2 -0/9 -0.8 4.9

15.7 13.0 7.9 6.7

Calculate the difference in reimbursement or charges:

Estimated revenue from third MS-DRG parties (based on a hospital payment rate of $5500) 86,251 2 216 50,809 232 30,787 237 27,964

Your hospital's average charges

Difference

$89,500 $49,500 $32,000 $25,000

-3,249 1,309 -1,213 2,964

4 Copyright ©2020 by the American Health Information Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, photocopying, recording or otherwise without prior permission from the publisher.

5. be?

For this group of patients only, determine what the estimated revenue from third parties would

MS-DRG 2 216 232 237

Estimated revenue from third parties (based on a hospital payment rate of $5500) 86,251 50,809 30,787 27,964

No. of patients (estimate) Estimated reimbursement 3 107 240 156

$258,753 $5,436,563 $7,388,880 $4,362,384

6. Based on this information, if you had to choose one procedure to add to your surgical product line, which one would it be and why?

Application Exercises 1.

See the report below for Community Hospital for November. Calculate the following hospital statistics. Bed Count Adults and children Newborn Admissions Adults and children Newborn Discharges (including deaths) Adults and children Newborn Inpatient Service Days Adults and children Newborn Total Length of Stay Adults and children Newborn Deaths...