The IPF PPS is based on a federal perdiem amount that represents the average daily operational, ancillary, and capital costs...

Principles of Healthcare Reimbursement

Student Workbook Chapter 6

Medicare-Medicaid Prospective Payment Systems for Inpatients

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Activities Theory into Practice and Real-World Case The Medicare Provider Analysis and Review (MedPAR) file is a database that the Centers for Medicare and Medicaid Services maintains. For each year, it includes the records from all the claims for hospital discharges of Medicare beneficiaries. The MedPAR file contains several gigabytes of data per year. Rather than being an inert archive, these data can be used to improve the quality of care for Medicare beneficiaries (Ash et al. 2003; Stringham and Young 2005).

The MedPAR file is an administrative database. The data include many administrative fields, such as diagnosis and procedure codes, claim costs and charges, the diagnosis-related group (DRG) and—as of fiscal year 2008—MS-DRGs, and the length of stay. However, as an administrative database, it has limitations to its usefulness as a means of assessing the quality of patient care. The database does not include some clinical risk factors, such as the results of diagnostic tests. The number of other diagnoses used to record complications and comorbidities is restricted to eight. The benefits of using the database, though, far outweigh the limitations. Cost is minimal. The database already exists. No forms or procedures need to be created. No data collectors need to be hired nor trained. Data collection occurs in the usual course of business. Finally, though, research has found that the MedPAR file can be used to assess the quality of patient care for both Medicare patients and other-payer patients (Needleman et al. 2003).

Ash and colleagues used MedPAR claims data to predict mortality in patients who had suffered acute myocardial infarction (AMI). They studied the years 1995 through 1999 with more than 300,000 cases per year (305,468; 308,997; 306,224; 304,882; 306,175; totaling 1,531,746). The validation data showed up to 80 percent mortality one year post-AMI for cases in the highest risk group. Moreover, the authors found that, prior to the AMI in the study, the patients had had a previous AMI, diabetes, or congestive heart failure. This information about health status at admission is important for the care of patients and for the improvement of care outcomes (Ash et al. 2003).

Stringham and Young used the MedPAR file to examine rates of urinary tract infections (UTI) at acute inpatient hospitals (Stringham and Young 2005). The authors noted that Medicare makes additional payments for complications, even complications that are possibly preventable. Frequently, the Medicare payment system has paired DRGs: one DRG for the condition and one DRG for the condition with a complication or comorbidity (CC). The relative weight of the DRG with the CC is higher than the relative weight for the DRG without the CC.

Nosocomial UTIs are an example of a potentially preventable complication. The authors explained that more expensive anti-infective catheters and staff training can reduce the rate of nosocomial UTIs. The authors’ study was designed as follows:

• All patients discharged during October 1, 2001 through September 30, 2002 as reported in the MedPAR file

• Identification of all cases with ICD-9-CM codes of 599.0 (urinary tract infection) or 996.64 (infection and inflammatory reaction due to indwelling urinary catheter)

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• Elimination of cases in which urinary tract infection was the principal diagnosis or in which the Major Diagnostic Category was 18 (Infectious and Parasitic Diseases)

The total cases that resulted with qualifying UTIs were 1,012,041 of the 12,502,700 discharges. For the 1,000 hospitals with the most discharges in the MedPAR data set, the rate of secondary UTI ranged from 3.10 percent to 15.49 percent. The authors examined the cases of one New York hospital in detail. They found that the hospital received approximately $675,000 more in Medicare payments because of the nosocomial UTIs. The more expensive, anti-infective catheters would have cost approximately $50,000. The authors hypothesized that payment policies of the Centers for Medicare and Medicaid Services (CMS) discouraged the implementation of initiatives to reduce nosocomial complications. Finally, the authors concluded that patients would benefit from improved quality of healthcare if the CMS ceased paying extra for nosocomial infections. The MedPAR file is a valuable tool to study the quality of patient care. Therefore, in addition to being an abstract payment system for some people, Medicare’s prospective payment system affects the health of all of us.

Application Exercises 1. IPF PPS: Use the information found in figures 1 and 2 (below), Tables 6.5-6.9 and

figure 6.7 from the textbook to complete table 1 and workbooks A&B in order to determine the IPF PPS reimbursement for this encounter. Additionally a Microsoft Excel file is provided if your instructor would like you to complete via Excel.

Figure 1: Facility Information

Bed size: 350 beds Location: Columbus, Ohio Classification: Rural Wage Index: .9806 Full Service ED: Yes Per-diem unadjusted rate (RY 2015): $728.31

Figure 2: Claim Information Admit Date: January 1, 2015 Discharge Date: January 15, 2015 LOS: 14 days Patient Age: 62 Principal Diagnosis: 295.34* Paraphrenic schizophrenia, chronic with acute

exacerbation Secondary Diagnosis: 301.6 Dependent personality disorder Secondary Diagnosis: 250.02 Type II diabetes mellitus uncontrolled MS-DRG: 885 Psychoses ECT treatments: 90870 3 units $315.55 per unit (RY 2015) *Diagnosis not converted to ICD-10-CM because service dates for this claim are prior to implementation of ICD-10-CM/PCS

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IPFPPS Payment Determination Steps (Use figure 6.7 from the textbook.)

Table 1 Step Methodology Total

A Wage Index:

$

B COLA:

$

C Base rate adjusted for geographic factors (Add steps A + B)

$

D Apply facility and patient adjustments - Use Worksheet A E Base rate adjusted for facility and patient adjustments (Multiply

steps C*D)

$

F If full service ED then choose higher Day 1 adjustment in step 7 If not full service ED then choose lower Day 1 adjustment in step 7

G Adjust for daily costs - Use Worksheet B H Enter the results from Worksheet B $ I Calculate ECT payment – Remember to WI ECT payment

$

J Add the total from step H to the total ECT payment (step I) to calculate total IPF PPS Payment

$

Worksheet A

Table 1 Step D

A. Enter adjustment factor if rural location: Enter PPS adjustment factor in Table 1 Step D.

B. Enter adjustment factor if teaching facility: C. Enter adjustment factor for DRG: D. Enter adjustment factor for comorbidity: E. Enter adjustment factor for age: Multiply applicable adjustment factors together to determine PPS adjustment factor:

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Worksheet B

Table 1 Steps G&H

Day Adjustment Factor (Step D)

Base rate adjusted for facility and patient characteristics (Step C)

Multiply Adjustment Factor * Adjusted Base Rate

Day one Day two Day three Day four Day five Day six Day seven Day eight Day nine Day ten Day eleven Day twelve Day thirteen Day fourteen

TOTAL $ 2. IPPS: High cost devices are used in many inpatient surgery cases. The Safe-Cross®,

radio frequency total occlusion crossing system, is such a device. The Safe-Cross® guidewire is present on the following claim. First, complete an

inpatient payment calculation to determine whether this claim would qualify for a high cost outlier add-on payment. Second, calculate the total reimbursement for this claim, including the additional amount that the facility would receive for the high cost outlier if applicable. Does this facility have a profit or loss for this encounter?

The 2015 IPPS high-cost outlier threshold is $24,758; the hospital specific CCR is:

0.429; the hospital base rate is $6,200.00.

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Inpatient Claim Admit Date: January 1,

2015 Discharge Date:

January 10, 2015

Length of Stay:

9 days

Principal Diagnosis: 410.71 Subendocardial infarction, initial episode of care

Secondary Diagnosis: 414.01 Coronary atherosclerosis of native coronary artery

Secondary Diagnosis: 427.1 Paroxysmal ventricular tachycardia

Secondary Diagnosis: 272.0 Pure hypercholesterolemia

Principal Procedure:

00.66 Percutaneous transluminal coronary angioplasty

Secondary Procedure: 36.07 Insertion of drug-eluting coronary artery stent

Secondary Procedure: 39.29 Other vascular shunt or bypass

Secondary Procedure: 37.22 Left heart cardiac catheterization

MS-DRG: 246 RW: 3.2368

Percutaneous cardiovascular procedure with drug-eluting stent with major complication/comorbidity or 4+vessels/stents

Claim Detail Revenue

Code Revenue Code Description Charge

110 Room & board – private $8,375.00 120 Room & board – semi private $3,700.00 200 Intensive care – general $5,910.00 206 Intensive care – intermediate ICU $2,780.00 250 Pharmacy – general $1,486.66 255 Pharmacy – drugs incident to radiology $728.13 258 Pharmacy – IV solutions $1,583.60 259 Pharmacy – other pharmacy $7,766.18 270 Medical/surgical supplies – general $8,256.00 272 Medical/surgical supplies – sterile supply $8,366.25 272 The Safe-Cross® guidewire $15,000.00 278 Medical/surgical supplies – other implants $28,623.00 301 Laboratory –chemistry $2,739.00 302 Laboratory – Immunology $648.00 305 Laboratory – Hematology $2,335.00 323 Laboratory – Arteriography $2,491.00 360 Operating room – general $23,875.00 361 Operating room – minor surgery $517.00 370 Anesthesia - general $209.00

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390 Blood and blood component admin, process, storage - gen $668.00 410 Respiratory services – general $21.00 420 Physical therapy - general $314.00 430 Occupational therapy – general $441.00 480 Cardiology – general $5,629.00 481 Cardiology – cardiac cath lab $6,249.00 483 Cardiology - echocardiology $1,786.00 710 Recovery room – general $1,648.00 730 EKG/ECG - general $1,098.00 921 Other diagnostic services – peripheral vascular lab $359.00

TOTAL CHARGE: $143,601.80

IPPS Outlier: If the cost of the case is greater than the fixed-loss cost threshold then an outlier add-on payment is warranted. The fixed-loss cost threshold equals the MS-DRG payment + the HC outlier threshold amount for the applicable year. Outlier Add-on Amount is equal to 80 percent of the difference between the cost of the case and the fixed-loss cost threshold.

3. IPPS: Calculating Case Mix Index. This exercise includes three data sets. The first is

an example of how to calculate CMI. The second and third data sets are for student completion. Additionally, the data sets are available via Excel for completion.

CMI Calculation Example Collect the applicable relative weight and volume for each MS-DRG included in

study period.

MS- DRG MDC TYPE MS-DRG Title 2015 RW Vol

Weighted Volume

405 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W MCC 5.5387 15

406 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W CC 2.8067 55

407 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 1.9472 78

Calculate the weighted volume for each MS-DRG by multiplying the MS-DRG relative weight by the Volume.

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MS- DRG MDC TYPE MS-DRG Title

2015 RW Vol

Weighted Volume

405 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W MCC 5.5387 15 5.5387 x 15

406 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W CC 2.8067 55 2.8067 x 55

407 07 SURG PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 1.9472 78 1.9472 x 78

MS- DRG MDC TYPE MS-DRG Title

2015 RW Vol

Weighted Volume

405 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W MCC 5.5387 15 83.0805

406 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W CC 2.8067 55 154.3685

407 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 1.9472 78 151.8816

Once all of the weighted volumes have been calculated sum them.

MS- DRG MDC TYPE MS-DRG Title

2015 RW Vol

Weighted Volume

405 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W MCC 5.5387 15 83.0805

406 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W CC 2.8067 55 154.3685

407 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 1.9472 78 151.8816

TOTALS 148 389.3306

CMI

To calculate the CMI for the data set, divide the Total Weighted Volume by the Total Volume.

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MS- DRG MDC TYPE MS-DRG Title

2015 RW Vol

Weighted Volume

405 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W MCC 5.5387 15 83.0805

406 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W CC 2.8067 55 154.3685

407 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 1.9472 78 151.8816

TOTALS 148 389.3306

CMI

389.3306 / 148

MS- DRG MDC TYPE MS-DRG Title

2015 RW Vol

Weighted Volume

405 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W MCC 5.5387 15 83.0805

406 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W CC 2.8067 55 154.3685

407 07 SURG

PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC 1.9472 78 151.8816

TOTALS 148 389.3306

CMI 2.6306

The CMI for this data set is 2.6306. Be sure to carry enough precision (decimal points)for the required use.

Data Set Two – CMI Calculation for Top MS-DRGs (Also available in Excel file format)

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MS-DRG MS-DRG Title MDC TYPE RW Volume Weighted Volume

470 Major joint replacement or reattachment of lower extremity w/o MCC 8 SURG 2.1137 420

392 Esophagitis, gastroent & misc digest disorders w/o MCC 6 MED 0.7388 332

194 Simple pneumonia & pleurisy w CC 4 MED 0.9688 295

247 Perc cardiovasc proc w drug-eluting stent w/o MCC 5 SURG 2.0586 280

293 Heart failure & shock w/o CC/MCC 5 MED 0.6762 246

313 Chest pain 5 MED 0.6138 233

292 Heart failure & shock w CC 5 MED 0.9824 232

690 Kidney & urinary tract infections w/o MCC 11 MED 0.7794 219

192 Chronic obstructive pulmonary disease w/o CC/MCC 4 MED 0.719 218

871 Septicemia w/o MV 96+ hours w MCC 18 MED 1.8072 213

641 Nutritional & misc metabolic disorders w/o MCC 10 MED 0.7051 209

291 Heart failure & shock w MCC 5 MED 1.5097 193

885 Psychoses 19 MED 1.0217 188

312 Syncope & collapse 5 MED 0.7423 177

287 Circulatory disorders except AMI, w card cath w/o MCC 5 MED 1.129 173

195 Simple pneumonia & pleurisy w/o CC/MCC 4 MED 0.7044 172

310 Cardiac arrhythmia & conduction disorders w/o CC/MCC 5 MED 0.5493 171

603 Cellulitis w/o MCC 9 MED 0.8447 143

379 G.I. hemorrhage w/o CC/MCC 6 MED 0.6776 137

191 Chronic obstructive pulmonary disease w CC 4 MED 0.937 131

65 Intracranial hemorrhage or cerebral infarction w CC 1 MED 1.0643 128

683 Renal failure w CC 11 MED 0.9512 116

189 Pulmonary edema & respiratory failure 4 MED 1.2136 114

69 Transient ischemia 1 MED 0.6985 110

66 Intracranial hemorrhage or cerebral infarction w/o CC/MCC 1 MED 0.753 102

4952

CMI

Totals

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Data Set Three – CMI Calculation for MDC 5 (Also available in Excel file format)

MS- DRG MDC TYPE MS-DRG Title

Relative Weight Volume

Weighted Volume

001 PRE SURG

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC 25.3920 25

002 PRE SURG

HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC 15.6820 32

215 05 SURG OTHER HEART ASSIST SYSTEM IMPLANT 15.4348 54

216 05 SURG

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC 9.5238 12

217 05 SURG

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC 6.3291 24

218 05 SURG

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W/O CC/MCC 5.5693 60

219 05 SURG

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC 7.7067 23

220 05 SURG

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC 5.2056 45

221 05 SURG

CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O CC/MCC 4.6347 78

222 05 SURG

CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCC 8.6570 25

223 05 SURG

CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC 6.2924 62

224 05 SURG

CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC 7.6733 44

225 05 SURG

CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC 5.8610 98

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226 05 SURG

CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC 6.9573 67

227 05 SURG

CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC 5.4493 85

228 05 SURG OTHER CARDIOTHORACIC PROCEDURES W MCC 7.3113 45

229 05 SURG OTHER CARDIOTHORACIC PROCEDURES W CC 4.4606 68

230 05 SURG OTHER CARDIOTHORACIC PROCEDURES W/O CC/MCC 4.0755 97

231 05 SURG CORONARY BYPASS W PTCA W MCC 7.7247 45

232 05 SURG CORONARY BYPASS W PTCA W/O MCC 5.5976 72

233 05 SURG CORONARY BYPASS W CARDIAC CATH W MCC 7.3493 68

234 05 SURG CORONARY BYPASS W CARDIAC CATH W/O MCC 4.8816 105

235 05 SURG CORONARY BYPASS W/O CARDIAC CATH W MCC 5.7089 45

236 05 SURG CORONARY BYPASS W/O CARDIAC CATH W/O MCC 3.7952 71

237 05 SURG MAJOR CARDIOVASC PROCEDURES W MCC 5.0843 32

238 05 SURG MAJOR CARDIOVASC PROCEDURES W/O MCC 3.4241 28

239 05 SURG

AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC 4.7590 5

240 05 SURG

AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC 2.7594 6

241 05 SURG

AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W/O CC/MCC 1.4111 8

242 05 SURG PERMANENT CARDIAC PACEMAKER IMPLANT W MCC 3.7242 32

243 05 SURG PERMANENT CARDIAC PACEMAKER IMPLANT W CC 2.6695 45

244 05 SURG

PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC 2.1555 89

245 05 SURG AICD GENERATOR PROCEDURES 4.6485 77

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246 05 SURG

PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTS 3.2368 68

247 05 SURG PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC 2.0586 104

248 05 SURG

PERC CARDIOVASC PROC W NON- DRUG-ELUTING STENT W MCC OR 4+ VES/STENTS 3.0411 78

249 05 SURG PERC CARDIOVASC PROC W NON- DRUG-ELUTING STENT W/O MCC 1.8808 125

250 05 SURG

PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC 2.9885 100

251 05 SURG

PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC 2.0399 124

252 05 SURG OTHER VASCULAR PROCEDURES W MCC 3.2646 52

253 05 SURG OTHER VASCULAR PROCEDURES W CC 2.5532 31

254 05 SURG OTHER VASCULAR PROCEDURES W/O CC/MCC 1.7304 22

255 05 SURG

UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC 2.6051 3

256 05 SURG

UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC 1.6986 2

257 05 SURG

UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W/O CC/MCC 1.0558 1

258 05 SURG CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC 2.7613 24

259 05 SURG CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC 1.9924 34

260 05 SURG

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC 3.7456 66

261 05 SURG

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC 1.8552 78

262 05 SURG

CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC 1.3978 81

263 05 SURG VEIN LIGATION & STRIPPING 1.8664 5

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264 05 SURG OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 2.8292 21

265 05 SURG AICD LEAD PROCEDURES 2.8641 25

266 05 SURG ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC 8.9920 20

267 05 SURG ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC 6.7517 21

280 05 MED

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC 1.7289 23

281 05 MED

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC 1.0247 10

282 05 MED

ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC 0.7562 11

283 05 MED ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC 1.6753 13

284 05 MED ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC 0.7703 33

285 05 MED

ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC 0.5065 21

286 05 MED

CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC 2.1240 11

287 05 MED

CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC 1.1290 16

288 05 MED ACUTE & SUBACUTE ENDOCARDITIS W MCC 2.7138 24

289 05 MED ACUTE & SUBACUTE ENDOCARDITIS W CC 1.6991 60

290 05 MED ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC 1.2476 45

291 05 MED HEART FAILURE & SHOCK W MCC 1.5097 30 292 05 MED HEART FAILURE & SHOCK W CC 0.9824 12

293 05 MED HEART FAILURE & SHOCK W/O CC/MCC 0.6762 31

294 05 MED DEEP VEIN THROMBOPHLEBITIS W CC/MCC 1.0480 5

295 05 MED DEEP VEIN THROMBOPHLEBITIS W/O CC/MCC 0.6926 6

296 05 MED CARDIAC ARREST, UNEXPLAINED W MCC 1.2347 7

15

297 05 MED CARDIAC ARREST, UNEXPLAINED W CC 0.6475 12

298 05 MED CARDIAC ARREST, UNEXPLAINED W/O CC/MCC 0.4227 13

299 05 MED PERIPHERAL VASCULAR DISORDERS W MCC 1.4094 14

300 05 MED PERIPHERAL VASCULAR DISORDERS W CC 0.9770 21

301 05 MED PERIPHERAL VASCULAR DISORDERS W/O CC/MCC 0.6776 24

302 05 MED ATHEROSCLEROSIS W MCC 1.0311 44 303 05 MED ATHEROSCLEROSIS W/O MCC 0.6101 51 304 05 MED HYPERTENSION W MCC 1.0016 13 305 05 MED HYPERTENSION W/O MCC 0.6272 23

306 05 MED CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC 1.3687 21

307 05 MED CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC 0.7698 20

308 05 MED

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC 1.2107 30

309 05 MED CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC 0.7865 6

310 05 MED

CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC 0.5493 1

311 05 MED ANGINA PECTORIS 0.5662 3 312 05 MED SYNCOPE & COLLAPSE 0.7423 2 313 05 MED CHEST PAIN 0.6138 14

314 05 MED OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC 1.9195 20

315 05 MED OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 0.9613 30

316 05 MED OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC 0.6210 50

TOTALS 3527

CMI

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References Ash, Arlene S., M.A. Posner, J.Speckman, S. Franco, A.C. Yacht, and L. Bramwell. 2003. Using claims data to examine mortality trends following hospitalization for heart attack in Medicare. Health Services Research 38(5):1253–1262.

Needleman, J., P.I. Buerhaus, S. Mattke, M. Stewart, and K. Zelevinsky. 2003. Measuring hospital quality: Can Medicare data substitute for all-payer data? Health Services Research 38(6 Part 1):1487–1508.

Stringham, J. and N. Young. 2005. Using MedPAR data as a measure of urinary tract infection rates: Implications for the Medicare inpatient DRG payment system. Perspectives in Health Information Management 2(12):1–14.