GMLOS
Hello fellow CDIS, my department has been looking at the LOS as it relates to the SOI. We are trying to determine why /how a pt can have a SOI of 1 with a LOS of 20+ days. In some cases we found that it was coder error, but others were due to various practices.
My question to you is do any of you share your GMLOS and you working with your medical staff and case managers?
If so, I would really like to hear how that is done, and if it has made an impact on revenue.
Thanks
Steph
Comments
we enter a working DRG in the EMR and case management can view it and share with providers as needed. We have seen improvements in LOS over the last several years which is likely due to several initiatives, this only being one.
There are a variety of reasons why a patient may have a low SOI and a long LOS but most often in our facility I see these are typically placement issues. There are also (of course) documentation issues that do not allow for accurate capture of SOI.
I am assuming you are evaluating OSI on those cases that are already falling out of GMLOS? It is important to note that comparing SOI to LOS is likely not the best measure as these are not equivalent metrics. SOI is specific to the disease process so patients with equivalent SOI are not expected to have equivalent. However if you are already filtering to those cases where your LOS is longer than GMLOS, SOI is a valuable tool to show providers how their documentation impacts these metrics.
This is the perfect example of how hospitals abuse the GMLOS. This is borderline fraud.
How is it 'fraud' to be concerned that note that GMLOS is being exceeded, analyzing the data, and looking for trends?
Paul Evans, RHIA, CCDS, CCS, CCS-P