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首页> 外文期刊>Quality management in health care >Change in MS-DRG assignment and hospital reimbursement as a result of Centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality?
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Change in MS-DRG assignment and hospital reimbursement as a result of Centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality?

机译：医疗保险和医疗补助中心因医院获得的条件而改变付款方式后，MS-DRG分配和医院报销发生了变化：是编码还是质量？

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CONTEXT: In October 2008, the Centers for Medicare & Medicaid Services reduced payments to hospitals for a group of hospital-acquired conditions (HACs) not documented as present on admission (POA). It is unknown what proportion of Medicare severity diagnosis related group (MS-DRG) assignments will change when the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code for the HAC is not taken into account even before considering the POA status. OBJECTIVES: The primary objectives were to estimate the proportion of cases that change MS-DRG assignment when HACs are removed from the calculation, the subsequent changes in reimbursement to hospitals, and the attenuation in changes in MS-DRG assignment after factoring in those that may be POA. Last, we explored the effect of the numbers of ICD-9-CM diagnosis codes on MS-DRG assignment. METHODS: We obtained 2 years of discharge data from academic medical centers that were members of the University Health System Consortium and identified all cases with 1 of 7 HACs coded through ICD-9-CM diagnosis codes. We calculated the MS-DRG for each case with and without the HAC and, hence, the proportion where MS-DRG assignment changed. Next, we used a bootstrap method to calculate the range in the proportion of cases changing assignment to account for POA status. Changes in reimbursement were estimated by using the 2008 MS-DRG weights payment formula. RESULTS: Of 184,932 cases with at least 1 HAC, 27.6% (n = 52,272) would experience a change in MS-DRG assignment without the HAC factored into the assignment. After taking into account those conditions that were potentially POA, 7.5% (n = 14,176) of the original cases would change MS-DRG assignment, with an average loss in reimbursement per case ranging from Dollars 1548 with a catheter-associated urinary tract infection to Dollars 7310 for a surgical site infection. These reductions would translate into a total reimbursement loss of Dollars 50 261,692 (range: Dollars 38 330,747-Dollars 62 344,360) for the 86 academic medical centers. Those cases, for all conditions, with reductions in payment also have fewer additional ICD-9-CM codes associated. CONCLUSIONS: Removing HACs from MS-DRG assignment may result in significant cost savings for the Centers for Medicare & Medicaid Services through reduced payment to hospitals. As more conditions are added, the negative impact on hospital reimbursement may become greater. However, it is possible that variation in coding practice may affect cost savings and not reflect true differences in quality of care.
机译：背景：2008年10月，医疗保险和医疗补助中心降低了因入院时未记录的一组医院获得性疾病（HAC）而支付给医院的费用。未知甚至在甚至没有考虑到HAC的国际疾病分类，第9修订版，临床修改（ICD-9-CM）诊断代码的情况下，Medicare严重性诊断相关组（MS-DRG）分配的比例会改变多少？考虑POA状态。目标：主要目标是估计从计算中删除HAC时更改MS-DRG分配的病例比例，随后的医院报销变化以及考虑到可能导致MS-DRG分配变化的衰减成为POA。最后，我们探讨了ICD-9-CM诊断代码数量对MS-DRG分配的影响。方法：我们从大学医疗系统协会成员的学术医疗中心获得了2年的出院数据，并通过ICD-9-CM诊断代码对7例HAC中的1例进行了鉴定。我们计算了有无HAC情况下每种情况的MS-DRG，因此计算了MS-DRG分配发生变化的比例。接下来，我们使用引导程序方法来计算更改分配以解决POA状态的案例所占的比例范围。通过使用2008 MS-DRG权重支付公式来估算费用的变化。结果：在184,932例具有至少1个HAC的病例中，有27.6％（n = 52,272）的MS-DRG分配发生了变化，而没有将HAC纳入分配。考虑到可能发生POA的情况后，原始病例的7.5％（n = 14,176）将改变MS-DRG的分配，每例的平均报销损失范围从1548美元的导管相关性尿路感染到7310美元用于手术部位感染。这些减少将使86个学术医疗中心的总补偿损失为50 261,692美元（范围：38 330,747美元-62 344,360美元）。在所有情况下，这些情况都随着付款的减少而减少了相关的附加ICD-9-CM代码。结论：从MS-DRG任务中删除HAC可能会减少对医院的付款，从而为Medicare和Medicaid Services中心节省大量成本。随着更多条件的加入，对医院报销的负面影响可能会更大。但是，编码实践中的变化可能会影响成本节省，并不能反映出护理质量的真正差异。

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