Examining Post Acute Care Relationships in an Integrated Hospital System. 3.5.2 Episode Length of Stay and Payment by Number of Hierarchical Condition Categories

02/01/2009

Table 3-12 shows the number and percent of beneficiaries in each DRG who have zero, one, two, three, four, or five or more HCCs, as well as the mean length of stay and Medicare payment for the overall episode and the index admission, by DRG and number of HCCs.

It is interesting to note the trends in the numbers of HCCs present by each DRG. For most DRGs, the largest proportion of beneficiaries had either two or three HCCs. DRG 014 (Stroke) is the only DRG examined for which all of the beneficiaries had at least one HCC (no beneficiaries have zero HCCs). Also, less than 1.0 percent of beneficiaries in either DRG 127 (Heart Failure & Shock) or DRG 210 (Hip & Femur Procedures) had zero HCCs. However, the majority of beneficiaries with DRG 544 (Joint and Limb Procedures) had no HCCs (43.0 percent). Beneficiaries with DRG 127 (Heart Failure & Shock) had the most HCCs, as 10.0 percent of them have five or more, compared with beneficiaries with DRG 544 (Joint and Limb Procedures), for which only 1.0 percent had five or more.

In looking at mean length of stay and payments, the general trend is that the mean length of stay and mean payment increase with increasing numbers of HCCs. On one hand, for DRG 014 (Stroke), beneficiaries with one HCC had an episode mean length of stay of 82.6 days and mean episode payments of $23,442. On the other hand, stroke beneficiaries with five or more HCCs had episode mean length of stay of 108.9 days and mean episode payments of $35,659. The largest difference in episode payment was noted for DRG 544 (Joint and Limb Procedures). The beneficiaries that had no HCCs had a mean episode payment of $17,774, compared to $35,319 for those who have five or more HCCs.

Table 3-11. 2006 Rank of HCCs Overall and for the Five Most Common DRGs1

    Total Sample N=109,236 DRG 014: Specific Cerebrovascular Disorders Except TIA (N=4,882) DRG 089: Simple Pneumonia & Pleurisy age > 17 w cc (N=4,675) DRG 127: Heart Failure & Shock (N=4,096) DRG 210: Hip & Femur Procedures except Major Joint, age > 17 w CC (N=3,552) DRG 544: Major Joint or Reattachment Procedures of Lower Extremity (N=15,261)
HCC Description Rank % Rank % Rank % Rank % Rank % Rank %
1. NOTE: FY 2006 DRG titles were used in this analysis.
SOURCE: RTI analysis of 2006 Medicare Claims 5% sample (ps01).
HCC80 Congestive Heart Failure 1 22.9 5 5.8 2 16.0 1 32.8 4 7.6 5 6.2
HCC92 Specified Heart Arrhythmias 2 21.4 3 9.4 3 11.6 2 15.1 2 8.4 3 9.8
HCC108 Chronic Obstructive Pulmonary Disease 3 20.4 6 4.5 1 20.3 3 11.1 3 8.2 4 9.5
HCC19 Diabetes without Complication 4 18.6 4 8.5 4 9.0 5 8.5 5 6.6 1 17.1
HCC131 Renal Failure 5 15.4 7 3.8 5 7.4 4 10.2 6 4.9 9 4.0
HCC79 Cardio-Respiratory Failure and Shock 6 8.2 13 0.9 6 5.9 6 3.1 10 1.8 11 2.3
HCC158 Hip Fracture/Dislocation 7 7.8 20 0.1 20 0.1 19 0.0 1 38.2 2 16.5
HCC164 Major Complications of Medical Care and Trauma 8 6.5 18 0.2 18 0.3 15 0.3 7 3.5 6 4.5
HCC105 Vascular Disease 9 6.4 8 2.1 7 2.2 8 2.1 8 2.1 10 2.8
HCC96 Ischemic or Unspecified Stroke 10 5.0 1 33.1 17 0.3 16 0.2 20 0.2 19 0.2
HCC83 Angina Pectoris/Old Myocardial Infarction 11 4.6 10 1.5 10 2.0 7 2.8 9 2.1 7 4.3
HCC2 Septicemia/Shock 12 4.3 16 0.3 13 0.7 14 0.3 19 0.3 20 0.1
HCC81 Acute Myocardial Infarction 13 4.1 15 0.4 15 0.6 20 0.0 14 0.7 15 0.5
HCC74 Seizure Disorders and Convulsions 14 4.0 9 2.1 9 2.1 10 0.8 11 1.4 12 1.4
HCC31 Intestinal Obstruction/Perforation 15 3.8 19 0.1 14 0.6 18 0.2 18 0.6 13 1.1
HCC21 Protein-Calorie Malnutrition 16 3.7 12 1.1 8 2.1 9 0.9 13 1.0 14 0.6
HCC111 Aspiration and Specified Bacterial Pneumonias 17 3.2 11 1.2 19 0.2 13 0.3 17 0.6 17 0.3
HCC38 Rheumatoid Arthritis and Inflammatory Connective Tissue Disease 18 3.0 14 0.6 11 1.6 11 0.7 12 1.2 8 4.1
HCC7 Metastatic Cancer and Acute Leukemia 19 3.0 17 0.3 16 0.6 17 0.2 16 0.6 18 0.3
HCC100 Hemiplegia/Hemiparesis 20 3.0 2 11.2 12 0.9 12 0.5 15 0.7 16 0.4

Table 3-12. 2006 Episode and Acute Index Admission Mean Length of Stay (LOS) & Payment by the Number of HCCs and Index DRG1

Index DRG N
HCCs
N % Index Admission Total Episode
Mean
LOS
Mean
LOS
Mean
LOS
Mean
Payment
1. NOTE: FY 2006 DRG titles were used in this analysis.
SOURCE: RTI analysis of 2006 Medicare Claims 5% sample.
014 Specific Cerebrovascular Disorders Except TIA (N=4,882) 1 843 17.3 4.5 $5,970 82.6 $23,442
2 1,570 32.2 5.0 $6,215 95.0 $27,826
3 1,348 27.6 5.9 $6,386 103.6 $32,138
4 700 14.3 7.0 $7,134 102.0 $34,380
5+ 421 8.6 9.4 $7,962 108.9 $35,659
089 Simple Pneumonia & Pleurisy Age > 17 w CC (N=4,675) 0 379 8.1 5.3 $4,968 62.8 $16,096
1 1,125 24.1 5.3 $4,998 68.5 $15,909
2 1,394 29.8 6.0 $5,098 70.0 $17,236
3 1,009 21.6 6.7 $5,173 74.1 $18,787
4 558 11.9 7.6 $5,526 81.5 $20,093
5+ 210 4.5 8.1 $5,775 92.9 $23,241
127 Heart Failure & Shock (N=4,096) 0 4 0.1 5.5 $4,935 45.8 $23,969
1 407 9.9 4.8 $5,078 79.2 $18,131
2 1,112 27.1 5.4 $5,193 87.0 $20,040
3 1,279 31.2 6.1 $5,416 94.5 $23,235
4 884 21.6 6.9 $5,619 92.1 $22,914
5+ 410 10.0 7.8 $5,906 100.4 $28,350
210 Hip & Femur Procedures except Major Joint Age > 17 w cc (N=3,552) 0 5 0.1 4.2 $8,164 86.0 $23,986
1 758 21.3 5.1 $9,543 90.0 $29,426
2 1,223 34.4 5.5 $9,834 94.9 $31,589
3 855 24.1 6.2 $9,913 102.9 $34,201
4 445 12.5 7.4 $10,486 103.7 $34,785
5+ 266 7.5 9.6 $10,990 110.6 $37,477
544 Major Joint Replacement or Reattachment Procedures of Lower Extremity (N=15,261) 0 6,507 42.6 3.5 $10,385 56.0 $17,724
1 4,770 31.3 4.0 $10,504 62.5 $20,998
2 2,340 15.3 4.7 $10,656 72.5 $25,276
3 1,032 6.8 5.8 $10,774 87.0 $28,568
4 414 2.7 6.9 $11,077 86.8 $30,807
5+ 198 1.3 9.8 $12,194 98.7 $35,319

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