Administrative Memos

200702

FROM: Theodore O. Will, Chief Executive Officer
DATE: Nov 01, 2007
SUBJECT: IPRO HPMP Special Project Statewide Remeasurement Report - Reduction of Payment Errors for DRGs 174 & 182
IPRO CONTACTS:

George Davis, Ph.D., Assistant Director, Data Analysis, Medicare/Federal Healthcare Assessment, 516-209-5217

Enclosed please find a copy of IPRO's Aggregate Remeasurement Report on Reduction of Payment Errors in DRG 174 (Gastrointestinal Hemorrhage with complication/comorbidity) and DRG 182 (Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders age >17 with CC). Baseline case review results of a random sample of FY 2006 discharges for these DRGs from 20 NYS short-term, acute care hospitals revealed an overall payment error rate of 13.3%. Review of the re-measurement sample for these same hospitals identified a payment error rate of 8.0%.

The overall re-measurement payment error rate of 8.0% (24/300) represents a significant

reduction in comparison to the 13.3% (80/600) denial rate at baseline (p<0.05). Admission denials decreased from 8.0% at baseline to 4.7% at re-measurement and the coding denial rate went from 5.7% at baseline to 3.3% at re-measurement.

Interestingly, we also found a statistically significant reduction between the baseline and remeasurement payment errors for the 'high-involvement' hospitals (i.e., those for whom IPRO requested an improvement plan). We found a marginal but non-significant reduction for the 'low-involvement' hospitals (i.e., those for whom involvement in statewide efforts was voluntary).

A complete list of hospital suggested improvement measures were shared in the August/September 2007 issue of UR Alert, IPRO's electronic utilization improvement newsbrief (see www.ipro.org/hpmp to subscribe or download issues).

If cases from your hospitals were selected for our study, then in addition to the aggregate report (see Attachment I), a hospital-specific comparative report is also provided (see Attachment II).

IPRO encourages all hospitals to continue to make use of all of the project resources, which may be found at http://www.ipro.org/gi.

Should you have any questions about this Memorandum or, the project, please feel free to contact George Davis at 516-209-5217 or by email at gdavis@nyqio.sdps.org.

Suggested Distribution List:

IPRO Liaison
Medical Director
Compliance Officer
Director of Utilization Management/Quality Improvement
Director of Health Information Management
Risk Manager
Chief Executive Officer