Performance Measurement in the Hospital Outpatient Setting. Most Commonly Provided Services/Procedures and Associated Diagnoses in the Hospital Outpatient Setting and Emergency Department

02/01/2008

Tables 3.2 and 3.3 highlight the 20 most common classes of services/procedures, grouped by APC, and their associated diagnoses in the HOPS and ED setting, respectively, based upon the analysis of 2005 Medicare data. For each of the APCs presented in the table, the five most common primary diagnosis groups associated with the APC are presented. In some cases, findings cluster into fewer than five key diagnostic categories, so fewer than five are listed. Additionally, Tables 3.2 and 3.3 present the physician specialty most likely to provide the given service/procedure, as distinguished from the ordering specialty (i.e., the physician requesting the service/procedure, but not actually providing it).

The most frequent services/procedures in the HOPS were ancillary services/procedures commonly used to diagnose and treat many different clinical symptoms and conditions. These include radiology services (e.g., x-rays, computed tomography (CT) scans, ultrasound), surgical pathology (i.e., Level III pathology, commonly used by pathologists and dermatologists), electrocardiograms, and drug administration. Most primary services/procedures (e.g., cataract extraction, angiography, arthroscopic surgery), while frequent, do not rise to the top of the OPPS services/procedures because they are dwarfed by the volume of ancillary services. The most common HOPS service/procedure (X-ray) accounted for 12 percent of the total services/procedures examined; and every other service/procedure listed in the top 20 for the HOPS accounted for five percent or less, each, of the total.

As in the HOPS, the most frequent services/procedures in the ED were ancillary services/procedures, especially radiology services. In the ED, the top few services/procedures account for a larger proportion than in the HOPS and the proportion represented by other services/procedures diminishes quickly thereafter. For example, the top two most common services/procedures in the ED -- X-rays and electrocardiograms-- accounted for approximately 30 percent and 16 percent, respectively, of the services/procedures included in these analyses; the remaining top 20 each accounted for nine percent or less of the total of services/procedures included in these analyses.

The total number of any one or a group of related services/procedures may have important implications when considering performance measures. While the overall volume of services/procedures is high — for example, in the 2005 Medicare data, there were over 78 million services/procedures performed in the HOPS and 22 million in the ED — as data are parsed at the hospital level to examine specific conditions or services/procedures, the sample size may be too small at the level of an individual hospital to be able to produce stable estimates of performance.

Rank Frequency Percent of Total APC APC Description Most Common Clinical Categories Within APC Specialty Providing Service
Table 3.3. Most Common Services/Procedures in the HOPS and Associated Diagnoses, Medicare 200523
1 9,526,216 12.13% 260 Level I Plain Film Except Teeth Medicine-General, Orthopedics, Medicine-Oncology/Neoplasia, Medicine-Cardiology, Urology Radiology, Facility
2 3,934,292 5.01% 343 Level III Pathology Medicine-GI, Medicine-Oncology/Neoplasia, Medicine-General, Dermatology, Surgery-General Pathology, Dermatology
3 3,049,223 3.88% 99 Electrocardiograms Medicine-General, Medicine-Cardiology, Orthopedics, Medicine-Oncology/Neoplasia, Surgery-General Internal Medicine, Cardiology
4 2,984,113 3.80% 301 Level II Radiation Therapy Medicine-Oncology/Neoplasia, Medicine-General Radiation Oncology
5 2,873,862 3.66% 283 Computerized Axial Tomography with Contrast Material Medicine-General, Medicine-Oncology/Neoplasia, Medicine-GI, Orthopedics, Urology Radiology, Facility
6 2,797,689 3.56% 437 Level II Drug Administration Medicine-Oncology/Neoplasia, Medicine-General, Medicine-Cardiology, Orthopedics, Medicine-Infectious Disease Facility
7 2,303,689 2.93% 95 Cardiac Rehabilitation Medicine-General, Medicine-Cardiology Cardiology
8 2,091,415 2.66% 266 Level II Diagnostic and Screening Ultrasound Medicine-General, Orthopedics, Urology, Gynecology, Medicine-GI Urology, Radiology
9 1,831,696 2.33% 409 Red Blood Cell Tests Medicine-Oncology/Neoplasia, Medicine-General, Orthopedics, Medicine-Cardiology, Medicine-GI Laboratory

 

Rank Frequency Percent of Total APC APC Description Most Common Clinical Categories Within APC Specialty Providing Service
Table 3.3. Most Common Services/Procedures in the HOPS and Associated Diagnoses, Medicare 2005 (continued)
10 1,765,455 2.25% 440 Level V Drug Administration Medicine-Oncology/Neoplasia, Medicine-General, Medicine-Cardiology, Orthopedics, Dermatology Facility
11 1,622,281 2.07% 697 Level I Echocardiogram Except Transesophageal Medicine-Cardiology, Medicine-General, Cardiology, Internal Medicine
12 1,467,273 1.87% 143 Lower GI Endoscopy Medicine-GI, Medicine-General, Medicine-Oncology/Neoplasia Gastroenterology, General Surgery, Internal Medicine
13 1,377,463 1.75% 433 Level II Pathology Medicine-Oncology/Neoplasia, Medicine-GI, Medicine-General, Urology, Surgery-General Pathology
Laboratory            
14 1,351,504 1.72% 304 Level I Therapeutic Radiation Treatment Preparation Medicine-Oncology/Neoplasia, Medicine-General Radiation Oncology
15 1,217,589 1.55% 368 Level II Pulmonary Tests Medicine-General Family Practice, Internal Medicine
16 1,200,061 1.53% 438 Level III Drug Administration Medicine-Oncology/Neoplasia, Medicine-General, Medicine-Cardiology, Orthopedics, Medicine-GI Facility
17 1,175,648 1.50% 325 Group Psychotherapy Psychiatry Psychiatry
18 1,160,024 1.48% 332 Computerized Axial Tomography and Computerized Angiography without Contrast Medicine-General, Medicine-Oncology/Neoplasia, Orthopedics, Urology, Neurology Radiology, Facility
19 1,058,882 1.35% 267 Level III Diagnostic and Screening Ultrasound Medicine-General, Neurology, Medicine-Cardiology, Orthopedics, Dermatology Cardiology, Vascular Surgery
20 1,017,665 1.30% 399 Nuclear Medicine Add-on Imaging Medicine-General, Medicine-Cardiology Radiology, Cardiology

 

Rank Frequency Percent of Total APC APC Description Most Common Clinical Categories Within APC Specialty Providing Service
Table 3.4. Most Common Services/Procedures in the ED and Associated Diagnoses, Medicare 200524
1 6,638,015 29.51% 0260 Level I Plain Film Except Teeth Medicine-General, Orthopedics, Medicine-Cardiology, Medicine-GI, Surgery-General Radiology, Facility
2 3,595,431 15.98% 0099 Electrocardiograms Medicine-General, Medicine-Cardiology, Medicine-GI, Orthopedics, Neurology Internal Medicine, Cardiology
3 1,984,224 8.82% 0437 Level II Drug Administration Medicine-General, Orthopedics, Surgery-General, Head and Neck, Medicine-GI Facility
4 1,913,623 8.51% 0438 Level III Drug Administration Medicine-General, Medicine-GI, Orthopedics, Medicine-Cardiology, Urology Facility
5 1,834,962 8.16% 0332 Computerized Axial Tomography and Computerized Angiography without Contrast Medicine-General, Head and Neck, Urology, Orthopedics, Neurology Radiology, Facility
6 1,223,868 5.44% 0440 Level V Drug Administration Medicine-General, Medicine-GI, Urology, Orthopedics, Medicine-Cardiology Facility
7 756,543 3.36% 0077 Level I Pulmonary Treatment Medicine-General Family Practice, Internal Medicine
8 587,764 2.61% 0261 Level II Plain Film Except Teeth Including Bone Density Measurement Medicine-General, Orthopedics, Medicine-GI, Urology, Head and Neck Radiology, Facility
9 507,923 2.26% 0283 Computerized Axial Tomography with Contrast Material Medicine-General, Medicine-GI, Orthopedics, Urology, Surgery-General Radiology, Facility
10 382,798 1.70% 0024 Level I Skin Repair Head and Neck, Surgery-General, Medicine-General, Orthopedics Dermatology

 

Rank Frequency Percent of Total APC APC Description Most Common Clinical Categories Within APC Specialty Providing Service
Table 3.4. Most Common Services/Procedures in the ED and Associated Diagnoses, Medicare 2005 (continued)
11 306,538 1.36% 266 Level II Diagnostic and Screening Ultrasound Medicine-General, Orthopedics, Dermatology, Medicine-GI, Urology Urology, Radiology, Surgery
12 274,110 1.22% 409 Red Blood Cell Tests Medicine-General, Medicine-GI, Medicine-Oncology/Neoplasia, Orthopedics, Urology Laboratory
13 270,657 1.20% 58 Level I Strapping and Cast Application Orthopedics Emergency Medicine, Podiatry
14 248,571 1.11% 340 Minor Ancillary Procedures Urology, Medicine-General, Medicine-GI, Orthopedics, Head and Neck Urology, Ophthalmology
15 154,572 0.69% 697 Level I Echocardiogram Except Transesophageal Medicine-General, Medicine-Cardiology, Neurology Cardiology
16 143,991 0.64% 282 Miscellaneous Computerized Axial Tomography Medicine-General, Orthopedics, Head and Neck Radiology, Facility
17 124,793 0.55% 345 Level I Transfusion Laboratory Procedures Medicine-General, Medicine-GI, Medicine-Oncology/Neoplasia Laboratory
18 111,433 0.50% 267 Level III Diagnostic and Screening Ultrasound Medicine-General, Orthopedics, Neurology, Dermatology, Medicine-Cardiology Cardiology, Vascular Surgery, Radiology
19 87,602 0.39% 269 Level II Echocardiogram Except Transesophageal Medicine-General, Medicine-Cardiology, Neurology, Orthopedics, Medicine-GI Cardiology
20 80,297 0.36% 399 Nuclear Medicine Add-on Imaging Medicine-General, Medicine-Cardiology Radiology, Cardiology

 

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