CHLA uses the All Patient Refined Diagnosis Related Groups (APR-DRG
) classification system to assign diagnosis and severity to each patient at discharge.
Although DRG weight often determines the FPL payment cap, all-patient refined (APR-DRG
) weight is a more granular measure of severity.
Then, all patient episodes were grouped using AP-DRG v25.0 and APR-DRG
Comorbidities were assessed using the APR-DRG
system in order to adjust 30-day mortality.
Physicians would receive an incentive distribution if their performance in the demonstration was between the 90th and zsth percentile for the lowest cost of care in that APR-DRG
We also included measures capturing severity of illness, using the All-Patient Refined Diagnosis-Related Group (APR-DRG
) severity-of-illness measure (from 3M Health Information Services) on the NIS, and the patient's level of risk of experiencing an adverse event.
Data elements obtained were age, sex, race, hospital (HUP or PPMC), admission as a transfer from another facility (i.e., outside hospital, long-term care facility, rehabilitation center), location within the hospital at the time of culture (i.e., intensive care unit or not intensive care unit), length of hospital stay before culture, prior admission to HUP or PPMC within the past 30 days, Charlson index (22), and all-patient refined--diagnosis-related group (APR-DRG
[All Patient Refined Diagnosis Related Groups] severity of illness doubled just by paying attention to having those diagnostic statements put in," he said.
For more than a year, the State of Maryland has been using the APR-DRG
severity-adjustment system from 3M Health Information Systems as the basis for its all-payer hospital rate-setting system.
Products included in the agreement are the 3M Coding and Reimbursement System, 3M Physician Coding and Reimbursement System, 3M Coding Reference Software, 3M All Patient Refined DRG (APR-DRG
) Software, 3M Audit Expert Inpatient and Outpatient Software, as well as 3M Health Record Management Software and the 3M Care Management System.
The records included hospital identifier, date, principal and additional diagnoses as International Classification of Diseases (ICD; World Health Organization, Geneva) codes, All-Patient-Refined Diagnosis-Related Group (APR-DRG
; 3M Inc., Murray, UT)--a broader classification based on Medicare diagnosis-related groups, sex, age, ethnic group, and residence zip code.
3M's All Patient Refined Diagnosis-Related Group (APR-DRG
) system for the non-Medicare population expands the basic DRG structure by adding four severity subclasses to each DRG: minor, moderate, major, and extreme.