Average CC/MCC Capture Rate?

mdomineseymdominesey
edited May 2016 in CDI Talk Archive
Does anybody have any statistics regarding the average CC/MCC capture rate? Maybe broken down by Surgical DRGs and Medical DRGs? Ideal would be broken down by DRG! (also, a reference would be great!)

Thanks so much in advance for your help!

Mark

Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
Clinical Documentation Excellence
Sr. Clinical Documentation Improvement Specialist
Sibley Memorial Hospital
Information Technology
5255 Loughboro Rd NW
Washington DC, 20016-2695
W: 202.660.6782
F: 202.537.4477
mdominesey@sibley.org
http://www.sibley.org

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Mark,
    Do you have access to your hospitals PEPPER report? It shows the general data for surgical and medical as a whole for your facility as compared to your state and national data. I just looked at my most recent one and if I am reading it correctly the overall CC/MCC capture rate for surgical is 60.2% for the top 80% (which is where you want to be, or better) for Q2FY2012. Medical is 67.5.
    I think I get this from our consulting group broken down further. Let me take a look....

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Mark,
    I do have this data broken down for our common DRGs for national data for the 80%. However, it is in a file I cannot edit and get to you without all our own personal data as well. If you have some specific DRG's, I would be happy to look them up for you. We are getting this data from our consulting group so I am not sure where it is coming from originally. It seems to me like this would be fairly available though. Maybe from CMS?

    Also, I should mention, both the data from PEPPER and from our consulting group is focused exclusively on Medicare patients....

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • sharon.colesharon.cole
    edited May 2016
    Mark,
    We have a Scorecard application that gives national benchmarks for MCC capture rate, CC capture rate, Surgical MCC/CC DCs vs Surgical DC and Medical MCC/CC DCs vs Medical DC. It's based only on traditional Medicare cases and is set up based on our hospital size (250-300 beds). If that is what you are looking for email me and I can share those benchmark numbers with you.

    Sharon Cole, RN, CCDS
    Providence Health Center
    Case Management Dept
    254.751.4256
    Sharon.cole@phn-waco.org
  • wchenneywchenney
    edited May 2016
    Can you post them on the blog?



    Wendy R. Chenney RN BSN
    Manager Clinical Documentation
    Parma Community General Hospital
    (440) 743-4533
    Fax: (440) 743-4552
    Pager: (440) 675-5929
  • mdomineseymdominesey
    edited May 2016
    I use the PEPPER extensively. What it does tell us is only "percentile" ranking. I.e. - it places hospitals in rankings of percentages of where they are in relation to other peer hospitals. The percentiles do not translate into percentages of DRGs with CCs/MCCs. If a hospital is at the 25th percentile, that means that 75% of their peers have more CC/MCC capture than they do....

    In my last place, we had a consultant company that was able to extract MEDPAR data to be very specific - down to the DRG and pairs. I have no such resource at present.

    Thanks so much,

    Mark


    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Clinical Documentation Excellence
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    F: 202.537.4477
    mdominesey@sibley.org
    http://www.sibley.org
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    What I am looking at in our PEPPER shows our ranking but also our % of CC/MCC capture as well as the CC/MCC capture rate of the 20% and 80% for juris/state/natl. At least that's how I'm reading it, now you have me wondering if I'm confused....
    Regardless, PEPPER is only so helpful because it doesn't drill down to specialty or DRG. Hopefully you can find what you are looking for :)


    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • mdomineseymdominesey
    edited May 2016
    I did reread the graphs - indeed the PEPPER gives us our average % of CC/MCC in aggregate, then that is placed in the graph with 20% and 80% delineated. It is useful in a global measure, but as you wrote Katy, its usefulness is constrained because we have no information about individual DRGs and pairs/triplets are not singled out.

    I have made up a spreadsheet for comparison of my top 25 DRGs - it goes into 32 because some of the pairs/triplets with CCs also show up. I put weights in, formulas in, and calculated out to making the "average" capture which is somewhere around 60% for medical and 50% for surgical. I am working on adding some formulas to delineate the impact if I could reach the average and the 80%. Pretty detailed stuff. I will try and pretty it up a bit and send it off to Melissa (add another task!) Maybe turn it into a database with pivot tables to use in forecasting?

    Thanks so much Katy for helping to get me straight!

    Mark


    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    http://www.sibley.org
    mdominesey@sibley.org
  • don.cdi.rn@gmail.comdon.cdi.rn@gmail.com
    edited May 2016
    Mark,

    I believe the data you want can be extractated from the CMS final rule table 7a/b. A is medpar data pushed through the v29/FY12 grouper & B is v30/FY13 grouper. The FY13 final rule uses data from FY11. This specific table is focused on LOS at various percentiles, but also gives total number of discharges for each DRG.

    table title:
    Table 7B Medicare Prospective Payment System Selected Percentile Lengths of Stay; FY2011 MedPAR Update - March 2012 Grouper V30.0 MS-DRGs

    First two columns: MS-DRG Number of Discharges
    Sample data (the 2 pneumonia sets):
    177 72,512
    178 62,812
    179 14,699
    or
    194 199,666
    195 83,130
    196 7,270

    To make most effective use of table 7 data, one needs to add a couple of columns to the annual table 5 (the drg table). I add one of 7 "codes" for each drg (triplet none, triplet cc, triplet mcc, etc.). I also add a code for "base drg" so that I can look at things solely by pdx & not whether there are secondaries -- so for 194/5/6, each belongs to the base drg for 'simple pna'. I haven't updated my FY12 table to the new final rule (yet)...

    With the these two tables (modified 5 & 7) loaded into a database, and cross with a table that is your facility drg volumes, it becomes relatively easy to establish benchmarks compared to the medpar data however one wants to slice.

    Another useful source of data is the "FY_13_FR_Impact_File". That gives very interesting data by individual hospital, including beds, CMI, LOS, average daily census & much more! With a little massage, can develop comparisons for similar hospitals (beds, rural vs urban, CMI, etc.)

    Another OUTSTANDING benchmarking source of data is if your hospital system happens to be in University Healthsystems Consortium -- if your system is, and you can get access to the data (which shouldn't be difficult), there is enough data there to keep me tied up for days or weeks!! :) :) :) :)
    Of course, the advantage of the CMS tables is that EVERYONE can access (just have to be prepared to do the number crunching and set up).

    The PEPPER report is an excellent resource, but sometimes drilling down to more detail is needed and the final rule tables allows some of that.

    This data analysis I've described above has long been something I've wanted to write up, perhaps even to publish.... if only there was an extra day in the week!!

    Mark, feel free to contact me if you would like to discuss further.

    Don


    Donald A. Butler, RN, BSN
    Manager, Clinical Documentation
    Vidant Medical Center, Greenville NC
    DButler@vidanthealth.com ( mailto:mDButler@vidanthealth.com )
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Glad you worked something out. And I'm not crazy in my interpretation of the graphs. Sometimes I think the data is going to kill me!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404
  • mdomineseymdominesey
    edited May 2016
    I will call you, Don, to chat about this - I think there is great opportunity to help the community out with this type of information and analysis.

    I followed some of your suggestions and searched via Google, and I ended up here: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY-2013-IPPS-Final-Rule-Home-Page.html

    At the bottom of the page are the links to the tables. I will crunch a bit today and see what I get.

    Thanks so much for your assistance and direction.

    Mark



    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Clinical Documentation Excellence
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    F: 202.537.4477
    mdominesey@sibley.org
    http://www.sibley.org.
  • angelisa.romanelloangelisa.romanello
    edited May 2016
    Hello Mark,
    I tried to open the image and it was empty. I would enjoy reviewing your DRG spreadsheet if you can send it again.

    Thank you,


    Lisa Romanello, RN,BSN,FNS,CCDS
    CDI Specialist
    CJW Medical Center
    Chippenham Campus
    804-228-6527
  • mdomineseymdominesey
    edited May 2016
    Sorry, the image that came attached was the logo for my hospital. Replying to someone whose message started out in plain text makes your own message plain text. The logo image from the original html email then becomes attached.

    I have not finalized my spreadsheet, it is pretty crude right now. I am swirling about thinking of the best way to do this to benefit the greatest number of people. Don and Katy's help has been great. The info about how to get available data from Don helps to establish somewhat standard benchmarks and the help from Katy on how best to interpret the PEPPER is great for establishing a "customizable" start.

    Mark


    Mark N. Dominesey, RN, BSN, MBA, CCDS, CDIP
    Clinical Documentation Excellence
    Sr. Clinical Documentation Improvement Specialist
    Sibley Memorial Hospital
    Information Technology
    5255 Loughboro Rd NW
    Washington DC, 20016-2695
    W: 202.660.6782
    F: 202.537.4477
    mdominesey@sibley.org
    http://www.sibley.org
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