Examining Post Acute Care Relationships in an Integrated Hospital System. Appendix B

02/01/2009

Table B-1. Utilization1 and Payment, by Claim Type, by DRG and APR-DRG Severity Index2, for Live Discharges, 2005
APR-DRG Severity of Illness Level
DRG   N %
with
Claim
Mean
Use
Mean
Payment
N %
with
Claim
Mean
Use
Mean
Payment
N %
with
Claim
Mean
Use
Mean
Payment
N %
with
Claim
Mean
Use
Mean
Payment
544 Major Joint and Limb Reattachment Procedures of Lower Extremity (N=12,970) APR-DRG 1
N=4,133
APR-DRG 2
N=5,999
APR-DRG 3
N=2,726
APR-DRG 4
N=112
  Total Episode Days (Index Admission Days + PAC days) 4,133 31.9* 59.0 $18,288 5,999 46.3* 64.9 $21,428 2,726 21.0* 70.0 $23,925 112 0.9* 95.4 $36,628
  Index Admission (Days) 4,133 100.0 3.7 $10,214 5,999 100.0 4.2 $10,506 2,726 100.0 5.1 $10,623 112 100.0 12.8 $15,078
  Home Health (Visits) 2,724 65.9 16.6 $3,341 4,046 67.4 17.7 $3,442 1,914 70.2 20.0 $3,648 62 55.4 29.0 $4,945
  IRF (Days) 965 23.3 9.3 $10,128 1,638 27.3 10.6 $11,352 806 29.6 11.6 $12,299 31 27.7 16.4 $14,834
  LTCH (Days) 13 0.3 26.1 $26,425 39 0.7 30.0 $30,207 41 1.5 28.8 $29,218 8 7.1 45.1 $57,427
  Hospital Outpatient Therapy (Services) 1,827 44.2 49.9 $1,074 2,151 35.9 50.6 $1,123 709 26.0 46.0 $1,131 29 25.9 52.0 $1,381
  SNF (Days) 1,218 29.5 18.1 $6,025 2,422 40.4 24.1 $7,656 1,252 45.9 25.8 $8,152 67 59.8 34.9 $10,492
  Acute Readmission (Days) 426 10.3 6.4 $11,386 971 16.2 7.3 $11,193 538 19.7 9.7 $13,308 39 34.8 10.7 $11,406

 

089  
Simple Pneumonia & Pleurisy Age >17 w CC (N=5,441)
APR-DRG 1
N=83
APR-DRG 2
N=2,712
APR-DRG 3
N=2,467
APR-DRG 4
N=179

1. Utilization is measured in days for acute, IRF, LTCH, and SNF; visits for HHA; and units of service for hospital outpatient therapy.
2. APR-DRG level 1 = Minor Severity; APR-DRG level 2 = Moderate Severity; APR-DRG level 3 = Major Severity; APR-DRG level 4 = Extreme Severity.

NOTE: * This is a row percent.

SOURCE: RTI analysis of 2005 Medicare Claims (mmor140).

  Total Episode Days (Index Admission Days + PAC days) 83 1.5* 71.0 $15,388 2,712 49.8* 67.6 $16,551 2,467 45.3* 75.5 $18,727 179 3.3* 77.3 $21,726
  Index Admission (Days) 83 100.0 5.3 $4,927 2,712 100.0 5.5 $4,886 2,467 100.0 7.1 $5,139 179 100.0 10.3 $5,462
  Home Health (Visits) 49 59.0 24.3 $2,909 1,424 52.5 23.2 $3,225 1,219 49.4 27.5 $3,666 89 49.7 25.1 $3,693
  IRF (Days) 2 2.4 25.0 $22,838 99 3.7 15.1 $15,824 79 3.2 14.8 $16,785 8 4.5 14.1 $19,031
  LTCH (Days) 0 0.0 - - 44 1.6 26.0 $30,721 57 2.3 28.9 $36,796 11 6.1 27.2 $28,852
  Hospital Outpatient Therapy (Services) 11 13.3 19.6 $678 476 17.6 34.3 $1,007 374 15.2 44.0 $1,447 24 13.4 30.1 $1,206
  SNF (Days) 45 54.2 34.2 $9,186 1,412 52.1 34.7 $9,376 1,459 59.1 35.9 $9,688 102 57.0 33.0 $9,190
  Acute Readmission (Days) 21 25.3 7.9 $12,343 789 29.1 10.8 $13,192 836 33.9 11.0 $13,102 77 43.0 12.0 $14,889

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