Health Information Management

Q&A: Improve hospital HealthGrades with CDI

CDI Strategies, February 5, 2009

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Note: ACDIS appreciates receiving questions from our readers. We cannot promise to answer every question but do occasionally put your concerns to our board. To ask a question, e-mail associate director Melissa Varnavas at or visit the ACDIS Blog.

Q: I’m looking for information regarding HealthGrades. Where does the formula and how can we improve our status through our CDI department?

A: HealthGrades’ America’s 50 Best Hospitals Award recognizes hospitals for consistent excellence by identifying those hospitals that have received HealthGrades’ Distinguished Hospital Award for Clinical Excellence (DHA-CE) designation for the most consecutive years. It is a healthcare ratings organization, which provides ratings and profiles of hospitals, nursing homes, and physicians to consumers and is headquartered in Golden, CO.

“The first thing to do is conduct a chart audit to determine documentation areas of weakness and opportunity,” says Gloryanne Bryant, BS, RHIA, RHIT, CCS, corporate director of coding HIM compliance at Catholic Healthcare West in San Francisco, CA. This helps you determine what areas to focus on to improve your status.

Make sure your CDI staff concentrates on all diagnoses not just the diagnoses which impact DRG and payment, says Tamara Hicks, RN, BSN, CCS, manager, care coordination at North Carolina Baptist Hospital in Winston-Salem, NC. “We track these as ‘severity’ queries as opposed to ‘DRG’ queries.”

HealthGrades uses 3M’s APR-DRG grouper to calculate severity scores. APR-DRG scores depend on proper ICD-9-CM diagnosis and procedure code assignments that portray severity of illness, says Robert Gold, MD, CEO of DCBA, Inc., in Atlanta, GA. Furthermore, the organization takes into account patient demographics and anything that appears on the UB-04 form.

“If your docs give you the correct documentation that leads to assignment of the correct codes, and if the coders assign and sequence those codes so the ones with the highest SOI (severity of illness) and ROM (risk of mortality) appear in the top nine positions on the UB-04, and the important procedures appear in the top five positions, you’ll do as well as you can,” Gold says.

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