Assignment Task:
The Medicare Provider Analysis and Review (MedPAR) file is a database that the Centers for Medicare and Medicaid Services maintains. For each year, it includes the records from all the claims for hospital discharges of Medicare beneficiaries. The MedPAR file contains several gigabytes of data per year. Rather than being an inert archive, these data can be used to improve the quality of care for Medicare beneficiaries (Ash et al. 2003; Stringham and Young 2005). The MedPAR file is an administrative database. The data include many administrative fields, such as diagnosis and procedure codes, claim costs and charges, the diagnosis related group (DRG) and-as of fiscal year 2008-MS-DRGs, and the length of stay. However, as an administrative database, it has limitations to its usefulness as a means of assessing the quality of patient care. The database does not include some clinical risk factors, such as the results of diagnostic tests. The number of other diagnoses used to record complications and comorbidities is restricted to eight. The benefits of using the database, though, far outweigh the limitations. Cost is minimal. The database already exists. No forms or procedures need to be created. No data collectors need to be hired nor trained. Data collection occurs in the usual course of business. Finally, though, research has found that the MedPAR file can be used to assess the quality of patient care for both Medicare patients and other-payer patients (Needleman et al. 2003). Ash and colleagues used MedPAR claims data to predict mortality in patients who had suffered acute myocardial infarction (AMI). They studied the years 1995 through 1999 with more than 300,000 cases per year (305,468; 308,997; 306,224; 304,882; 306,175; totaling 1,531,746). The validation data showed up to 80 percent mortality one year post-AMI for cases in the highest risk group. Moreover, the authors found that, prior to the AMI in the study, the patients had had a previous AMI, diabetes, or congestive heart failure. This information about health status at admission is important for the care of patients and for the improvement of care outcomes (Ash et al. 2003). Stringham and Young used the MedPAR file to examine rates of urinary tract infections (UTI) at acute inpatient hospitals (Stringham and Young 2005). The authors noted that Medicare makes additional payments for complications, even complications that are possibly preventable. Frequently, the Medicare payment system has paired DRGs: one DRG for the condition and one DRG for the condition with a complication or comorbidity (CC). The relative weight of the DRG with the CC is higher than the relative weight for the DRG without the CC. Nosocomial UTIs are an example of a potentially preventable complication. The authors explained that more expensive anti-infective catheters and staff training can reduce the rate of nosocomial UTIs. The authors' study was designed as follows: All patients discharged during October 1, 2001 through September 30, 2002 as reported in the MedPAR file Identification of all cases with ICD-9-CM codes of 599.0 (urinary tract infection) or 996.64 (infection and inflammatory reaction due to indwelling urinary catheter) Elimination of cases in which urinary tract infection was the principal diagnosis or in which the Major Diagnostic Category was 18 (Infectious and Parasitic Diseases) The total cases that resulted with qualifying UTIs were 1,012,041 of the 12,502,700 discharges. For the 1,000 hospitals with the most discharges in the MedPAR data set, the rate of secondary UTI ranged from 3.10 percent to 15.49 percent. The authors examined the cases of one New York hospital in detail. They found that the hospital received approximately $675,000 more in Medicare payments because of the nosocomial UTIs. The more expensive, anti-infective catheters would have cost approximately $50,000. The authors hypothesized that payment policies of the Centers for Medicare and Medicaid Services (CMS) discouraged the implementation of initiatives to reduce nosocomial complications. Finally, the authors concluded that patients would benefit from improved quality of healthcare if the CMS ceased paying extra for nosocomial infections. The MedPAR file is a valuable tool to study the quality of patient care. Therefore, in addition to being an abstract payment system for some people, Medicare's prospective payment system affects the health of all of us. After reading the above, should preventable infections warrant a higher DRG (and a higher payment)? How can these infections be better prevented? Want Professional Help?