Benchmark for MEDICAL CC/MCC Capture Rate

Assume – as quality of documentation rises, so too will the CC/MCC rates (APR-DRG Levels)

If so, How high can we expect the capture rate to rise?

Most CDI consulting firms use a benchmark of 50%-55% for a combined Surgical Capture Rate
(Source: Physician Queries Handbook, ACDIS, 2009)

I can find no benchmark for combined Medical Capture Rate? Any resources anyone can offer?

Paul Evans, RHIA, CCDS

Comments

  • edited April 2016
    Hi Paul,

    For our last report (ending in Dec 2013), our CDI consulting company reported the 80% benchmark as a combined CC/MCC capture rate for medical at 66% (29/37) and surgical at 60% (34/26). This is for Medicare ONLY.

    Hope that helps :)

    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
  • Thank you, Katy

    80% percentile @ 66% CC/MCC for Medical and 60% for surgical seems reasonable?
    See you in Vegas!



    Paul Evans, RHIA, CCS, CCS-P, CCDS
     
    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell:  415.637.9002

    evanspx@sutterhealth.org


  • edited April 2016
    Does this mean of all medical cases 80% should have one or other? And

    Sent from my iPhone

  • edited April 2016
    Stepping in since I haven't seen an answer:

    Typical meaning as Katy has phrased:
    At the 80th percentile performance (as opposed to the average
    performance at 50th percentile), 66% of medical DRGs will have either a
    cc or mcc.
    So, if your capture rate is 66%, you are doing better than 80% of all
    hospitals.

    The caveat on Katy's benchmark -- she did not say if the benchmark is
    based on MEDPARs data, or upon the consultant's internal data (which
    might consist of only their clients). Since the original question was
    for MEDPARs, and since that would be the more useful, I would presume
    the consultant benchmark is for MEDPARs data.

    Don


    Donald A. Butler, RN, BSN
    Manager, Clinical Documentation Advisor Program
    Vidant Health, Greenville NC
    DButler@vidanthealth.com
  • edited April 2016
    Sorry for the delay. The 80% benchmark is comparing to peers. It means that to be in the top 20% of hospitals for CC/MCC capture you would need a CC/MCC capture >66% for medical and >60% for surgical.
    As to Don's point about MEDPAR vs Consultant. I am honestly not 100% sure if that is internal benchmarking or MEDPAR....

    I hope that makes sense.

    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
  • Thank you,all. Good info

    Paul evans


    Sent from my iPhone
  • edited April 2016
    There was an interesting presentation at the conference (Multi-Facility
    Management: Using Data to Drive Improvement, Nancy Rae Ignatowicz) that
    referenced using MEDPARs data to benchmark MCC/CC capture rate, but
    adjusted the MEDPARs data to reflect your own institution's DRG
    distribution pattern.

    I believe that as long as one has their own DRG distribution, the data
    in the IPPS Table 7 can be used to come up with that adjusted benchmark.
    Need to think through a process and the math to recreate that
    benchmark.

    Essentially, what you are seeking to do is if the normal % of CHF DRGs
    in MEDPARs is 3%, and your hospital is 6%, a simple comparison will not
    provide as good of a benchmark as if one 'adjusts' the MEDPARs to
    reflect your DRG distribution and then calculate the MCC/CC capture.

    Don

    Donald A. Butler, RN, BSN
    Manager, Clinical Documentation Advisor Program
    Vidant Health, Greenville NC
    DButler@vidanthealth.com ( mailto:mDButler@vidanthealth.com )

  • edited April 2016
    I was wonder what is you CMI?


    Sent from my iPad

  • edited April 2016
    Our combined med/surg is right at 2. But as Don was saying, it's difficult to compare hospital to hospital with CMI (even more so than CC/MCC capture) because it is heavily influenced by the type of hospital and service lines available.

    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
  • edited April 2016
    There is the possibility of using the IPPS Final rule Impact File, that
    provides some interesting elements that allow the development of an
    approximate comparison group. With the data, one should be able to
    develop a slightly better comparative CMI, perhaps some LOS, cost, etc.
    for a fairly comparable selected group of hospitals.

    Don

    For EACH hospital in the country, data elements include:

    Provider Number

    Name

    URGEO
    Large urban, Other Urban or Rural designation of the providers
    geographic CBSA

    Resident to Bed Ratio

    BEDS

    Average Daily Census
    Calculated as the ratio of Total Acute Inpatient Days to Total Days in
    the Cost Reporting Period obtained from cost report data.**

    REGION
    1=NEW ENGLAND; 2=MIDDLE ATLANTIC; 3=SOUTH ATLANTIC; 4=EAST NORTH
    CENTRAL; 5=EAST SOUTH CENTRAL; 6=WEST NORTH CENTRAL; 7=WEST SOUTH
    CENTRAL; 8-=MOUNTAIN; 9=PACIFIC; 40=PUERTO RICO

    Provider Type
    Type of provider - key: 0=IPPS; 7=RURAL REFERRAL CENTER (RRC);
    8=INDIAN; 14=Medicare Dependent Hospital (MDH); 15=MDH/RRC; 16=Sole
    Community Hospital (SCH); 17=SCH/RRC; 21=ESSENTIAL ACCESS CMTY HSP
    (EACH); 22=EACH/RRC; Reflects expiration of Medicare Dependent Hospital
    payment status where providers have the provider type of 14 or 15 for FY
    2014.

    BILLS
    Total number of Medicare cases for the provider from the FY2012 MEDPAR,
    December 2012 Update

    CMIV30
    Case Mix Index under Grouper V30 for SCH/ former MDH providers paid
    under their Hospital Specific Payment rate

    CMIV31
    Case Mix Index under Grouper V31 for SCH providers paid under their
    Hospital Specific Payment rate

    MCR_PCT
    Medicare days as a percent of total inpatient days (not available for
    all providers that receive HSP rate)

    Proxy Value Based Purchasing Adjustment Factor
    Proxy payment adjustment for value based purchasing program (Section
    3001 of Affordable Care Act) based on performance scores from an older
    performance period.

    Final Readmission Adjustment Factor- Updated September 2013
    Payment adjustment for Hospital Readmissions Reduction Program (Section
    3025 of Affordable Care Act). Maryland and Puerto Rico hospitals are
    exempt from the payment adjustment. Readmission Adjustment Factors are
    based on excess readmission ratios from a performance period of July 1,
    2009 to June 30, 2012. The excess readmission ratios include the
    application of the planned readmissions algorithm.


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