Case mix analyses are performed to identify areas of risk and opportunity for improving clinical documentation in the medical record. This analysis is based upon the complicated case percentage for each of the DRG pairs with and without comorbidity, particularly those that have been the focus of investigation by the Office of Inspector General (OIG) for upcoding.
Using the Medicare Provider Analysis and Review (MEDPAR) data provided by Solucient for those DRG pairs, our consultants have special reports prepared to compare hospital customers against jointly defined national and regional peer groups. A hospital's selections for peer groups are based upon a combination of such Medicare Cost Report data elements as operating bed size, teaching/non-teaching status, urban/rural, Medicare inpatient percent length of stay and Medicare case mix index. St Clair has Solucient prepare a report showing the calculated mean of the peer groups, one standard deviation above and below mean, and the 25th/75th/90th percentiles for each DRG pair to compare with the hospital customers. In an on-site meeting, St Clair presents the preliminary analysis findings and recommendations, with a detailed final report to follow in two (2) weeks.
The analysis is insightful in explaining year to year changes in a hospital's case mix. The results of the analysis can be used in selecting the sample of inpatient cases to be reviewed in those DRGs where there is the most risk and/or opportunity.
The St Clair professional fee for a benchmark analysis is priced on a "per day" basis, plus out of pocket expenses for Solucient analytical reports and travel expenses.