ROM Improvement (Case Selection)

evanspx@sutterhealth.org

We report the Observed/Expect Mortality Ratio as a quality metric.   In this regard, utilization of ROM is an important factor.   I have been asked to perform some retrospective reviews of cases in order to determine if a CDI/Coding Review may positively impact the ROM for select cases.   Given that even a patient with a principal diagnosis of sepsis may have an ROM score of only '1', does anyone have any insight as to how I may perform case selection?  I was thinking about using select bio-markers, such Serum Cr,  Lactic Acid, Troponin, BNP, Procalcitonin, in conjunction with the coded principal diagnosis.   Has anyone other suggestions?

Thank you

laura.rogers@franciscanalliance.org

I may be stating the obvious, but ROM/SOI are both impacted by MCC's and CC's.  I would start by looking at all the lower weighted DRG's, i.e. DRG 872.

Have I completely misunderstood you?

Laura

evanspx@sutterhealth.org

There is some relationship between the MS-DRG structure and the APR-DRG structure, but the ROM assignment is so much more complicated than the ROM assigned by APR-DRG.  You are correct in that a strategy may be to review MS-DRGs lacking either CC and/or MCC.  But, I specifically wonder if someone may have more specific strategy or criteria I may employ?  

ccatlett1

Paul,  you may want to use a high risk, high volume and problem prone case strategy for case review. You may also want to work with your Revenue Cycle folks and identify cases that have demonstrated decreased margin contributions since ICD10 rolled out.  Of course, there is the Mortality & Morbidity review that we have found yields results.

Cheryl

evanspx@sutterhealth.org

Good idea, Cheryl  (Thank you)!