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Background |
Per Diem Analysis Module The Per Diem Analysis module starts with the Per Diem Overview tool, which summarizes results from all of the per diem analyses. This report lists hospitals whose average length of stay appears unusual in one or more of our analyses. For each hospital, the tool gives the number of claims and an estimate of how much its billing exceeds the norm based on a user-defined per diem rate. As in all of Health Data Desk's analyses, the "norm" is defined based on one of two different baselines, a national sample of hospitals or a summary of the payer's own data. Switching between baselines is as easy as clicking button.  For per diem payers, Health Data Desk analyzes each provider's typical length of stay. Here, "Hospital Y" has a median length of stay of 9 days for its pneumonia patients. The median length of stay for the rest of this payer's claims is only 5 days. The color of each point represents how statistically unusual that payer's behavior is. Red points have the most extreme lengths of stay. The Per Diem Distribution tool identifies hospitals that, for a given disease category, keep patients longer than the baseline. The tool considers the entire length-of-stay distribution, not just those hospitals with the longest stays. Therefore, clients can detect a hospital that keeps patients for three days instead of two (in the middle of the distribution) as easily as one keeping patients for six days instead of five (at the upper end of the distribution). The Excess Days function calculates, for selected hospitals, the difference between the number of actual hospital days and the number of days expected from baseline data. A client-supplied per diem dollar value converts the excess days to a dollar value opportunity. The Per Diem Trend tool tracks changes in a hospital's length of stay distribution over time. Individual hospital trends are compared with appropriate baselines. A hospital is flagged as anomalous if its length of stay distribution changes but its patient mix and the baseline do not.  For per diem payers Health Data Desk's case-adjusted model predicts each patient's length of stay using demographic and diagnosis data. When a provider's actual lengths of stay are much higher than the predicted stay based on our model, that provider will appear above the red line on the plot. Here, "Hospital R" seems to be keeping its pneumonia patients much longer than most other hospitals even after case-adjustment. The Per Diem Model Exception tool uses a proprietary case-mix-adjusted statistical model to predict the expected length of stay for each patient based on various demographic and coding variables. These predictions are summarized for each hospital to see how far a hospital's actual lengths of stay deviate from its predicted lengths of stay. Hospitals with stays that consistently exceed the model's predictions are flagged as suspicious. The Weekend Stay Distribution tool calculates the percentage of weekend days in hospital for each patient record and summarizes the results for each hospital. Hospitals with an unusually large percentage of weekend days can be examined more closely to see if there is a pattern of holding patients over the weekend in order to increase reimbursement. The Days to Procedure tool examines each hospital's median stay while waiting for a procedure. The Drill Down feature and Demographics Summaries tool compare the patient characteristics of selected hospitals with the baseline characteristics, for each disease category and displays detailed patient records for hospitals with anomalous behavior. The Claim Viewer displays detailed patient records for hospitals with anomalous behavior. |
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