title: Improving and measuring inpatient documentation of medical care within the MS-DRG system: education, monitoring, and normalized case mix index.
abstract: Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single department (neurosurgery) at our hospital. We measured subsequent documentation improvements in a simple, meaningful, and reproducible fashion. We created a new metric to measure documentation, termed the "normalized case mix index," that allows comparison of hospitalizations across multiple unrelated MS-DRG groups. Compared to one year earlier, the traditional case mix index, normalized case mix index, severity of illness, and risk of mortality increased one year after the educational intervention. We encourage other organizations to implement and systematically monitor documentation improvement efforts when attempting to determine the accuracy and quality of documentation achieved.
authors.affiliation: Benjamin P. Rosenbaum, MD, is a neurosurgery resident at Cleveland Clinic in Cleveland, OH.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Rosenbaum
authors.affiliation: Robert R. Lorenz, MD, MBA, FACS, is an otolaryngologist and medical director of payment reform, risk, and contracting at Cleveland Clinic in Cleveland, OH.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Lorenz
authors.affiliation: Ralph B. Luther, MBA, is a process improvement specialist at Cleveland Clinic in Cleveland, OH.
authors.forename: Ralph B
authors.initials: RB
authors.lastname: Luther
authors.affiliation: Lisa Knowles-Ward, RHIT, CCS, is director of coding and reimbursement at Cleveland Clinic in Cleveland, OH.
authors.forename: Lisa
authors.initials: L
authors.lastname: Knowles-Ward
authors.affiliation: Dianne L. Kelly, RN, is director of clinical documentation improvement at Cleveland Clinic in Cleveland, OH.
authors.forename: Dianne L
authors.initials: DL
authors.lastname: Kelly
authors.affiliation: Robert J. Weil, MD, MBA, FACS, is a neurosurgeon who previously worked at Cleveland Clinic in Cleveland, OH. He now works at Geisinger Health System in Danville, PA, as a neurosurgeon, chief medical executive for the northeast region, and associate chief scientific officer.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
mesh_terms: D059019:Clinical Coding; D003953:Diagnosis-Related Groups / Q000458:organization & administration*; D004282:Documentation / Q000379:methods*; D006739:Hospital Administration; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007318:Inservice Training / Q000458:organization & administration; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration*; D012720:Severity of Illness Index; D014481:United States
keywords: case mix index; risk of mortality; severity of illness; technical documentation