The way that Maryland’s hospitals are required to bill Medicare for long stay patients causes aberrations in Medicare quality scores that could be skewing hospitals’ quality data reported on Medicare’s Hospital Compare website, CMS Star Ratings and other organizations that use Medicare data such as Leapfrog, and US News & World Report.
Health Services Cost Review Commission (HSCRC) data, HSCRC quality scores and global budget adjustments are not affected.
At issue is interim claims often submitted for patients who are in the hospital longer than a month. To bring revenue in the door while the patient is still an inpatient and before they’re discharged, the hospital can submit a bill to Medicare at the end of each month. In all other states, the hospital then submits a final summary bill that includes all the diagnosis and procedure codes in the correct order so that the most important ones are listed first. This ensures that the case is assigned to the most appropriate DRG. Maryland’s hospitals are instructed by Medicare not to include everything on the last bill.
In calculating quality scores in Maryland, Medicare looks only at the last bill that is submitted — not earlier interim bills. As a result, a complication that occurs earlier in the stay may be missed, cases may be improperly included or excluded in the measurement, or cases may be assigned to the wrong diagnosis group or service line. The magnitude of the impact depends on how many interim bills a hospital submits. A hospital’s performance could appear to be better or worse than it is.
MHA will meet with state and federal regulators to alert them to the issue and propose steps to address the inaccurate measurement. MHA will also draft a letter alerting Leapfrog, and US. News & World Report to the issue.