Administrative Memos

200301

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 06, 2003
SUBJECT: Aggregate Data Report: Short Stay Hospitalizations
IPRO CONTACTS:

Kathy Terry, Ph.D., Senior Director, Data Analysis and Evaluation, Medicare/Federal Health Care Assessment, Ext. 261
Monty Bodenheimer, M.D., Medical Director, Medicare/Federal Health Care Assessment, Ext. 261

Enclosed please find a copy of IPRO's Aggregate Data Report (Attachment I) in regard to short stays hospitalizations. This report is based on IPRO's analysis of calendar year (CY) 1999 and CY 2000 New York State (NYS) Medicare inpatient claims data for patients with same or next day discharges.

IPRO reviewed a sample of CY 2000 inpatient discharges from 26 hospitals to determine the medical necessity of the inpatient admission. The aggregate error rate for this project was 30.9%, with 26.3% of these cases denied for failure to provide sufficient medical record documentation to support admission necessity. The remaining 4.6% of the aggregate error rate was attributed to technical denials (i.e., charts not submitted by the hospital).

We have enclosed a copy of the hospital-specific report (Attachment II) for the 26 hospitals selected for IPRO assessment. If your hospital had denials, a list of the denied cases is also provided (Attachment III).

The number of short stay inpatient admissions have continued to increase in New York State for calendar year 2001 to date. We encourage all hospitals to take a proactive approach and conduct routine monitoring of same and next day discharges to insure that these inpatient admissions are medically necessary as reflected by the documentation in the medical record. In addition, IPRO recommends that all hospitals:

Remind physicians about the importance of medical record documentation on the day of admission as to why the patient needs acute, inpatient services and his/her rationale for any procedures that are being considered. All findings on history, physical examination, and available tests that support the need for admission should be noted.
Discuss admitting practices with the emergency department and medical staff regarding medical necessity, reasonableness, and appropriateness of inpatient hospital admissions. Ensure that initial orders for care reflect the level of care to be provided.
Document all diagnoses and procedures as specifically as possible. Include details regarding why diagnostic studies are being ordered on an inpatient basis, as well as the results and plans for addressing abnormal findings.
Retrospectively review short-stay admissions to determine whether care might have been provided safely and effectively in an alternative setting.

Should you have any questions with regard to this report, please feel free to contact Monty Bodenheimer, M.D., Medical Director, Medicare/Federal Health Care Assessment, Ext. 261 or Kathy Terry, Ph.D., Sr. Director, Data Analysis, Medicare/Federal Health Care Assessment, Ext. 261.