FROM: Theodore O. Will, Chief Executive Officer
DATE: Jul 14, 2000
SUBJECT: Hospital-Specific DRG Pairs Report for Calendar Years (CY) 1998 and 1999
IPRO CONTACTS:
Kathy Terry, Ph.D., Director of Data Analysis, Extension 261
Recent compliance literature references twenty-one (21) DRG pairs that have been identified as "at risk" for potential upcoding. To assist hospitals in their efforts to identify and reduce Medicare inpatient payment errors, IPRO has produced the enclosed reports which list each of the 21 pairs identified as "at risk" along with the hospital-specific proportion for that pair.
The hospital-specific proportions may then be compared to the peer group and the New York State proportions which have also been provided. In the first report for CY 1998, national Medicare data is available and therefore, national percentages for these DRGs have included for comparison as well.
Please note that in both reports (1998 and 1999) the hospital specific and NY State proportions were calculated from Medicare inpatient claims excluding DRG exempt claims.
The last page of the enclosed Hospital-Specific DRG Pairs Report for CY 1998 and 1999 graphically displays three DRG pairs based upon the 1999 data. These DRGs have been selected by IPRO as Year One PEPP projects with DRG pair 174/182 under development. Although IPRO is not currently planning PEPP projects in regard to all of the 21 DRG pairs identified in this report, some of the pairs may be developed as DRG-PEPP projects in years two or three.
Obviously there are many reasons your hospital may differ in the ratio of any particular pair, and IPRO does not suggest that simply differing from your peer hospitals or the statewide average should be cause for concern. For example, variation might be explained by a combination of a hospital's clinical capabilities and its patient population. For pairs where a hospital's total number of discharges is small, random chance may be responsible. However, when there is a large variation from peer hospitals for a pair with a large number of discharges, systematic errors in documentation and/or coding may be an issue. Therefore, hospitals may wish to perform additional analyses to determine if these DRGs represent problem areas within their facility.
IPRO is planning three follow-up conference calls to provide hospitals with an opportunity to discuss any questions they may have in regard to these reports as well as to solicit your ideas for future PEPP reports which you feel would be useful. Each call will last one (1) hour. Please select one of the three available dates/times which follow, then call 1-888-902-5402 to register. (Note: the same agenda will be followed for all three calls, therefore it is only necessary for you to participate in one session.) The calls have been scheduled as follows:
To facilitate discussion on the calls, please fax your questions as well as any ideas for future PEPP reports to the attention of Dr. Kathy Terry at 516-328-2310 by Tuesday, July 25, 2000. Subsequent to the calls, IPRO plans to post a synopsis of the questions and answers, as discussed, as well as a listing of the suggestions for future PEPP reports to our web site.
In the interim, should you have any questions in regard to this report, please feel free to contact Andrea Goldstein, Vice President, Medicare/Federal Health Care Assessment or Dr. Kathy Terry.