Health Information Management

News: CMS releases provider use data

CDI Strategies, July 9, 2015

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Want to know what the top 10 MS-DRGs are in the country? Just ask CMS, which released its third annual update to the Medicare hospital inpatient and outpatient charge data in June. In fact, inpatient hospital data, by specific hospital, is available for the top 100 DRGs by volume.

The data—taken from the Medicare Providers Analysis and Review (MedPAR) dataset for fiscal year 2013—includes information on the number of discharges, and averages charges and payments, including total payments from all sources. Individual sites for fiscal years 2011, 2012, and 2013 contain both hospital-specific and national/state aggregate downloadable files, in either Excel or Comma Separated Value files. The data allows providers and others to easily compare hospitals in a specific area or compare a hospital to statewide and national averages. 

“While the hospital data is detailed, the physician data seems almost invasive,” says Kimberly Anderwood Hoy Baker, JD, regulatory specialist for HCPro. It lists the physician’s name, NPI, credentials, specialty, address, and even gender, she says. “Providers cannot exclude themselves from the data, but they should at least familiarize themselves with the data publicly available about them.”

So what is the top MS-DRG? Major joint replacement (DRG 470) continues to be the most frequently occurring discharge nationally with 446,148 total discharges and total allowed amount cost of $6.6 billion.

CDI professionals can use this data not only to interrogate the top MS-DRGs at their facility and target documentation reviews accordingly but also compare their facility against the nation and use such global data to earn physician and administrator support for program efforts.

Editor’s Note: Portions of this article were adapted from the Medicare Insider

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