Health Information Management

Patient acuity takes center stage with APR-DRGs

HIM-HIPAA Insider, March 31, 2014

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Most inpatient coders are very familiar with MS-DRGs and Base DRGs. They may not, however, be as familiar with APR-DRGs.

APR-DRG are designed to ensure payments are based on patient acuity rather than cost and are increasingly taking center stage as pay-for-performance initiatives move forward. APR-DRGs take into consideration all of the codes that coders assign and provide a detailed depiction of a patient's risk of mortality (ROM) and severity of illness (SOI).
"This system basically forms a clinically coherent set of patient groups that's used to identify severity of illness and risk of mortality," says Simone R. Gravesande, RN, BSN, senior manager, consulting services at 3M Health Information Systems in Atlanta. "What's extremely important is that [APR-DRGs] describe a full and complete cross-section of patients in all acute hospital settings."
State agencies and commissions often turn to APR-DRGs to distribute comparative performance data to regulators, payers, and the general public. Even if coders don't work with APR-DRGs directly, they should understand them and how they work, says Gravesande.
Continue reading "Patient acuity takes center stage with APR-DRGs" on the HCPro website. Subscribers to Briefings on Coding Compliance Strategies  have free access to this article in the March issue.

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