Question
The performance improvement committee of Community Regional Medical Center wanted to study MS-DRG 689 kidney and urinary tract infections with MCC (major complication or comorbidity)
The performance improvement committee of Community Regional Medical Center wanted to study MS-DRG 689 kidney and urinary tract infections with MCC (major complication or comorbidity) because of wide variations in length of stay (LOS) and total charges (refer to Chapter 15,Revenue Management and Reimbursement,for more information on MS-DRGs and MCCs). The committee asked the HIM director to show a profile of patients discharged from MS-DRG 689. A summary of the patients discharged from MS-DRG 689 at Community Hospital was prepared using information found in the hospital's online database. Further, research was performed on the individual patient records to determine if there was a correlation between the LOS and the MCCs for the patients.
A summary of the patients discharged from MS-DRG 689 at Community Hospital is presented inthe table below.
Data forReal-WorldCase14.1discussion
Case
Principal Diagnosis
Principal Procedure
Age
LOS
Discharge Destination
Charges
Payer
1
599.0
38.93
53.5
4
HOMEIV
$8,851
MEDICAID
2
599.0
45.13
28.2
7
HOMEHEALTH
$18,966
MEDICARE
3
590.8
45.5
3
HOME
$4,370
MANAGED CARE
4
590.8
86.27
27.9
3
HOMEHEALTH
$7,121
GOV MNGD CARE
5
590.8
38.8
3
HOME
$13,350
MEDICAID
6
590.8
45.23
67.1
4
HOME
$15,854
MANAGED CARE
7
599.0
39.95
88.5
6
SNF
$22,373
MEDICARE
8
599.0
27.8
6
HOMEHEALTH
$11,381
GOV MNGD CARE
9
590.1
52.6
2
HOME
$4,082
MEDICAID
10
599.0
81.9
6
HOMEHEALTH
$17,025
MEDICARE
11
590.8
23.3
3
HOME
$5,039
MEDICAID
12
599.0
43.11
90.1
5
HOMEHEALTH
$17,411
MEDICARE
13
599.0
99.6
91.3
1
UNKNOWN
$5,302
MEDICARE
14
599.0
88.72
73.1
4
HOME
$11,091
MEDICARE
15
599.0
81.3
12
SNF
$23,341
MEDICARE
16
590.8
45.16
74.7
4
HOMEHEALTH
$16,277
MEDICARE
17
599.0
71.2
5
HOMEHEALTH
$9,239
MEDICARE
18
599.0
79.3
7
SNF
$21,050
MEDICARE
19
590.1
31.3
4
HOME
$7,085
GOV MNGD CARE
20
590.8
38.93
74.1
13
ACUTECARE
$49,487
MEDICAID
21
599.0
65.7
2
HOMEHEALTH
$8,980
MEDICARE
22
599.0
86.27
83.1
5
SNF
$11,651
MEDICARE
23
599.0
77.0
5
SNF
$12,295
MEDICARE
24
599.0
99.04
81.2
7
HOMEHEALTH
$23,745
MEDICARE
25
599.0
43.3
10
HOMEHEALTH
$25,130
MEDICARE
26
599.0
81.5
3
SNF
$10,092
MEDICARE
27
599.0
38.93
25.6
3
HOMEIV
$8,722
MEDICAID
28
599.0
61.4
2
SNF
$6,670
MEDICAID
29
599.0
45.13
76.0
8
SNF
$17,741
GOV MNGD CARE
30
590.1
44.4
4
HOME
$10,800
MANAGED CARE
31
590.8
44.8
2
HOME
$10,916
MEDICAID
32
599.0
45.13
61.2
8
SNF
$32,796
MEDICARE
QUESTIONS:
- Calculate thelength of stayfor all patients.
- Calculatethe average length of stay for Medicare patients.
- Calculatethe average chargefor all patients.
- Calculatethe average charge for Medicaid patients.
- Calculatethe average ageof all patients.
- Calculatethe average age of patients discharged to skilled nursing facilities.
- Calculatethe average age of patients discharged home.
- Calculatethe ratio of Medicare patients to Medicaid patients.
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