Johnson Tricia, Kane Jason M, Odwazny Richard, McNutt Robert
Department of Health Systems Management, Rush University Medical Center, Chicago, Illinois.
J Hosp Med. 2014 Nov;9(11):707-13. doi: 10.1002/jhm.2253. Epub 2014 Sep 11.
Incentives to improve quality include paying less for adverse events, including the Centers for Medicare and Medicaid Services' policy to not pay additionally for events classified as hospital-acquired conditions (HACs). This policy is controversial, as variable coding practices at hospitals may lead to differences in the inclusion and position of HACs in the list of codes used for Medicare Severity Diagnosis-Related Group (MS-DRG) assignment.
Evaluate changes in MS-DRG assignment for patients with an HAC and test the association of the position of an HAC in the list of International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes with change in MS-DRG assignment.
Retrospective analysis of patients discharged from hospital members of the University HealthSystem Consortium's Clinical Data Base between October 2007 and April 2008. Comparisons were made between the MS-DRG assigned when the HAC was not included in the list of ICD-9 diagnosis codes and the MS-DRG that would have been assigned had the HAC code been included in the assignment.
Of the 7027 patients with an HAC, 13.8% changed MS-DRG assignment when the HAC was removed. An HAC in the second position versus third position or lower was associated with a 40-fold increase in the likelihood of MS-DRG change.
The position of an HAC in the list of diagnosis codes, rather than the presence of an HAC, is associated with a change in MS-DRG assignment. HACs have little effect on reimbursement unless the HAC is in the second position and patients have minor severity of illness.
提高医疗质量的激励措施包括对不良事件支付更少费用，其中包括医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）不额外支付被归类为医院获得性疾病（HACs）事件费用的政策。这项政策存在争议，因为医院不同的编码做法可能导致HACs在用于医疗保险严重程度诊断相关分组（MS-DRG）分配的编码列表中的纳入情况和位置存在差异。
评估患有HAC的患者在MS-DRG分配方面的变化，并测试HAC在国际疾病分类第九版（ICD-9）诊断编码列表中的位置与MS-DRG分配变化之间的关联。
对2007年10月至2008年4月期间大学卫生系统联盟临床数据库中成员医院出院的患者进行回顾性分析。比较了在ICD-9诊断编码列表中未包含HAC时分配的MS-DRG与如果在分配中包含HAC编码时本应分配的MS-DRG。
在7027例患有HAC的患者中，当去除HAC时，13.8%的患者MS-DRG分配发生了变化。与处于第三位置或更低位置相比，处于第二位置的HAC与MS-DRG变化可能性增加40倍相关。
HAC在诊断编码列表中的位置而非HAC的存在与MS-DRG分配的变化相关。除非HAC处于第二位置且患者疾病严重程度较轻，否则HAC对报销影响不大。
