| Background Description of the Hospital Efficiency IndexTM |
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The Hospital Efficiency Indices (HEI) represent statistical/actuarial methodologies for analyzing hospital inpatient admissions, length-of-stay (LOS) and days, as compared to benchmark most efficient practice, in order to estimate potentially avoidable admissions and days. The primary objective of the HEI is to compare any set of given inpatient hospital experience to the equivalent case-mix/severity adjusted most efficient practice found anywhere in the US. The results are all indexed to this common benchmark (most efficient practice) to determine potentially avoidable days and admissions and to readily allow direct comparisons on a consistent basis.
The methods used are statistical, not clinical, in nature, with clinical input on appropriate aspects, and actuarial judgment to produce reasonable and usable results. The HEI results report potentially avoidable days and admissions, but these results do not mean that the estimated avoidable days and admissions are inappropriate. Rather the results mean that, as adjusted for case-mix, severity, diagnoses, procedures and other statistical variables, these potentially avoidable days and admissions are in excess of benchmark levels. These excess levels can result because of less effective treatment patterns while in the hospital, or because disease management practices for chronic diseases are not implemented by providers or not adhered to by patients and thus, result in a higher frequency of admissions than in the benchmark hospitals. A patient could be sick enough that a hospital admission is necessary, however, on a statistical basis it could have been avoided had the patient been put on an appropriate drug or monitoring regimen. Furthermore, days at the end of an appropriate admission could be potentially avoidable (but necessary) because recovery is delayed due to a delay in scheduling a surgical procedure or other delays in the treatment process. The Hospital Efficiency Indices are developed in two parts – the LOS Efficiency Index™, used to determine avoidable days by LOS at the DRG and severity level, and the Admission Appropriateness Index™, used to determine potentially avoidable admissions within specialty and by DRG. The avoidable admissions are also converted to avoidable days. The development of the LOS Efficiency Index and Admission Appropriateness Index are described separately below followed by a description of the Charge Model. Note that either undercoding or upcoding of diagnoses and procedures, or any other data inaccuracies, could distort the results of these analyses. Separate Hospital Efficiency models are developed for Medicare inpatient care (Medpar data based on UB-92 information), and Commercial (HMO, PPO, indemnity) and Medicaid admissions using public data from 20 states. |