IDS Training Session - Outcome Measures

1. IDS Training Session - Outcome Measures

2. Webinar Features • To ask a question, first click the orange arrow button to enlarge the menu • Once the menu is enlarged, type in the box to ask a question • To make the presentation full screen, press the • middle blue button

3. Outcome Measures - Intro Outcome measure reports help hospital staff take a look at measureable quality (length of stay and mortality rate) for their hospitals and compare to others Very easy to filter and show hospitals of comparable size These reports can help in the process of improvement; should not be the only source, however

4. Goals • Understanding Severity Adjustment • Using the Severity Adjusted Reports • Creating Patient Lists • Using the Inpatient/Outpatient Comparison report • Using the Customized Ratio Report

5. Definitions • Length of Stay • When Admit Date = Discharge Date LOS defined as 1 • Peer Group • Based on Blue Cross Peer Groups • Useful for comparing to like hospitals

6. Understanding Severity • DRGs originally designed for all patients • Updates focus on Medicare population • Measures resource consumption (not mortality) • Measures complication/comorbidity • Comorbidity: the presence of one or more disorders (or diseases) in addition to a primary disease or disorder

7. APR-DRGs APR-DRGs are grouped on to each discharge using a grouper during MHA’s production process This grouper comes from 3M and is proprietary Grouper can not be ‘exported’ as the grouping goes on behind the scenes in a ‘black box’ It isn’t a 1 to 1 ratio – multiple MS-DRGs can make up one APR-DRG

8. APR-DRGs • APR DRGs are designed to measure: • Severity of Illness: the extent of physiologic decompensation or organ system loss of function • Risk of Mortality: the likelihood of inhospital death for a patient • Resource Intensity: the relative volume and types of diagnostic, therapeutic and bed services used

9. Length of Stay Notes • A complication / comorbidity is more likely to increase Severity of Illness than Risk of Mortality • LOS and Mortality evaluated independently • It is possible to have low level for LOS, but high level for mortality • Each APR-DRG has four levels: Minor, Moderate, Major, & Extreme

10. Example of Severity - LOS Diagnosis Uncomplicated Diabetes Diabetes w/ Renal Manifestation Diabetes w/ Ketoacidosis Diabetes w/ Hyperosmolar Coma Level 1. Minor except Moderate w/ CABG (Coronary artery bypass graft), Vaginal Delivery, etc. 2. Moderate 3. Major 4. Extreme

11. Mortality Notes • Each APR-DRG has four levels: Minor, Moderate, Major, & Extreme • LOS and Mortality evaluated independently • It is possible to have low level for LOS, but high level for mortality • Often need combinations of diseases for Extreme Risk of Mortality

12. Example of Severity - Mortality Diagnosis Uncomplicated Diabetes Diabetes w/ Renal Manifestation Diabetes w/Ketoacidosis Diabetes w/ Hyperosmolar Coma Level 1. Minor except – Major – Inflammatory Bowel Disease, etc. 2.Moderate except - Minor – Elective Procedures 2.Moderate except - Major w/ AMI Minor w/ Elective PX 3.Major

13. Other APR-DRG Modifiers Age Combination of non-Operating Room procedures and primary diagnoses Combinations of categories of secondary diagnoses

14. APR-DRG Norms Export Attain using the Export Wizard Sample is for Pneumonia & AMI Trimmed data = above or below the standard deviation for that APR-DRG Run this report to find out exactly how many discharges are in each level, or how the trim points are defined *Demo Data

15. Severity Adjusted LOS and Mortality Report

16. Report Tab 1 – Report Data First set the date range for the report Name the report if you intend to save it Include a description for easy recognition

17. Report Tab 2 – Report Settings To identify areas for improvement, select comparison data “Overall” and do not provide a filter statement

18. Report Tab 2 – Report Settings It is possible to report on Hospital ID and look at other hospitals and compare yours It is recommended to use the severity adjusted comparison in this case, however

19. Example Report Note – outliers have been removed Note areas of concern *Demo Data

20. Reporting by Physician • It is possible to use Physician as a level in the report • Be confident of credibility of data – ask data contact (person who sends MHA data) if data can be relied upon • Be careful – • Is attending physician really attending or the member of a group practice in charge of case? • Repeat analysis for previous years to see if anomaly or real trend

21. Severity Adjusted LOS – Trends Similar to first report, but allows user to trend LOS data Does not include Mortality data Easy to identify real trends and use for improvement

22. Sample Report *Demo Data

23. Severity Adjusted Mortality - Trends Similar to first report, but allows user to trend Mortality data Does not include LOS data Easy to identify real trends and use for improvement

24. Sample Report *Demo Data

25. Hospital Severity Adjusted Comparison Choose date range on first tab Choose one or two level report on second tab – one level must always be HospID Use overall comparison data unelss looking at a specific set of data

26. Peer Group Comparisons Filter on a specific hospital set (filter on hosp ID) Or filter on a peer group

27. Example Report *Demo Data

28. Identifying Issues – Patient Listings Report Patient listings report will allow you to take a look at patients that had a low probability of death Choose time period on Tab 1 – Report Data

29. Tab 2 – Report Settings • Set “Sorted By” to Expected Mortality • Ascending Sort Order • This will show patients with low probability of death first

30. Tab 3 – Report Filter Set “Disposition” to 20 (Expired) This will now show patients that died, but had a low probability of death first Can set a service line or MSDRG filter here

31. Example Report • Review cases with: • Low mortality rates • Few secondary diagnoses *Demo Data

32. Inpatient / Outpatient Comparison • Shows hospitals reliance on each type of patient • Can also be used to see what percentage of a procedure are performed in outpatient setting • On Tab 1, select date range • On Tab 2, select sort settings – cannot change level • On Tab 3, select filters – peer groups, particular hospitals, etc.

33. Sample IP / OP Comparison Index is obtained by comparing percent outpatient for each hospital to the average percent outpatient for all hospitals included *Demo Data

34. Customized Ratio Report • Reports by Hospital • Utilizes Numerator and Denominator Filter • Answers questions like: • What percentage of initial AMI patients have a CABG? PCTA? • How do I compare to other hospitals on potential issues?

35. C-Section Rate by Hospital Numerator Filter – MS-DRG 765-766 (C-Sections) Denominator Filter – MS-DRG 765-768, 774-775 (all deliveries) This report only includes cases in the numerator that are also in the denominator

36. C-Section Rate by Hospital Tab 1 – Choose date ranges Tab 2 – Choose sort order Tab 3 – Choose filter settings

37. Sample Report Index = Observed rate / Average rate *Demo Data

38. Other Example Report Ideas • Ratio of one DRG to another • Percentage of Medicare Discharged to Home for Hip Replacement • Numerator Filter: Disposition = 01,06,07 • Denominator Filter: MSDRG = 466-468 Pay Source = 01

39. Questions? Michael Ovsenik Client Representative Chris Leong Client Representative IDS Client Support idssupport@mha.org 517-886-8448 or 877-999-4653 Http://www.theidsonline.com