Patient states he feels weak and irritable. Patient states he often drinks 6-7 beers and a couple shots of hard liquor in a day and has done so for 10+ years. H&P: 55 y/o male presented to ER with vomiting for 3+ days. If these diagnoses are not captured in the documentation, then there may be a poor representation of the expected mortality. Coding these pre-existing medical conditions allows the data to be risk-adjusted and therefore impacts the expected mortality ratio for the patient. To categorize hospital performance, CMS compares each hospital’s RSMR to the national observed mortality rate.Įlixhauser Comorbidity Index identifies pre-existing medical conditions (risk factors) that would result in an impact on certain outcomes, such as mortality. Then, using statistical analysis, the hospital’s data is risk-adjusted and an estimated death rate called a risk-standardized mortality rate (RSMR) is calculated for each performance category (AMI, COPD, CHF, PNA, CVA, post-CABG). When CMS set out to score a hospital’s performance, they had to consider differences in the patient populations, so for each of the measures, CMS included an adjustment for what are called risk-adjusted factors, such as age, comorbid disease, and indicators of patient frailty.įor each patient, risk-adjustment variables (or risk-adjusted factors) are obtained from inpatient, outpatient, and physician Medicare administrative claims data extending 12 months prior to the index admission and all claims for the index admission itself. Over time, legislation formed surrounding the HQA data, forming the policies found in the quality and pay-for-performance provisions embedded in the Affordable Care Act (ACA) in 2010.ĬMS developed a website, Care Compare, that publicly reports hospital performance and rates the hospital’s performance by assigning them to one of three performance categories: The HQA set out with the mission to provide consumers with information regarding provider and/or hospital performance, allowing the consumer to make an informed choice as to which provider and where to receive their care. In December of 2002, the US Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) in a collaboration with the American Hospital Association, the Association of American Medical Colleges, and the Federation of American Hospitals, formed the Hospital Quality Alliance (HQA). Background for Elixhauser Comorbidity Index:

Spss code elixhauser comorbid score