Concurrent chart review provides more accurate documentation and increased calculated case mix index, severity of illness, and risk of mortality.
BACKGROUND
Case mix index (CMI) is calculated to determine the relative value assigned to a Diagnosis-Related Group. Accurate documentation of patient complications and comorbidities and major complications and comorbidities changes CMI and can affect hospital reimbursement and future pay for performance metrics.


METHODS
Starting in 2010, a physician panel concurrently reviewed the documentation of the trauma/acute care surgeons. Clarifications of the Centers for Medicare and Medicaid Services term-specific documentation were made by the panel, and the surgeon could incorporate or decline the clinical queries. A retrospective review of trauma/acute care inpatients was performed. The mean severity of illness, risk of mortality, and CMI from 2009 were compared with the 3 subsequent years. Mean length of stay and mean Injury Severity Score by year were listed as measures of patient acuity. Statistical analysis was performed using ANOVA and t-test, with p < 0.05 for significance.


RESULTS
Each year demonstrated an increase in severity of illness, risk of mortality, and CMI compared with baseline values (p < 0.05). Length of stay was not significantly different, reflecting similar patient populations throughout the study. Injury Severity Score decreased in 2011 and 2012 compared with 2009, reflecting a lower level of injury in the trauma population.


CONCLUSIONS
A concurrent documentation review significantly increases severity of illness, risk of mortality, and CMI scores in a trauma/acute care service compared with pre-program levels. These changes reflect more accurate key word documentation rather than a change in patient acuity. The increased scores might impact hospital reimbursement and more accurately stratify outcomes measures for care providers.
Department of Surgery, Baylor Scott & White, Temple, TX. Electronic address: RFRAZEE@sw.org.
Richard C
RC
Frazee
Department of Medicine, Barnabas Health System, West Orange, NJ.
Anthony V
AV
Matejicka
Department of Surgery, Baylor Scott & White, Temple, TX.
Stephen W
SW
Abernathy
Department of Surgery, Baylor Scott & White, Temple, TX.
Matthew
M
Davis
Department of Surgery, Baylor Scott & White, Temple, TX.
Travis S
TS
Isbell
Department of Surgery, Baylor Scott & White, Temple, TX.
Justin L
JL
Regner
Department of Surgery, Baylor Scott & White, Temple, TX.
Randall W
RW
Smith
University of Texas Medical Branch, Galveston, TX.
Daniel C
DC
Jupiter
Department of Surgery, Baylor Scott & White, Temple, TX.
Harry T
HT
Papaconstantinou
D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000458:organization & administration*; D004282:Documentation / Q000592:standards*; D057286:Electronic Health Records; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014193:Trauma Centers / Q000458:organization & administration*; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology