MDAR AQuality Comorbidity Analytics Solution
Medical Diagnosis Accuracy Reporting
THE PROBLEM OF INCOMPLETE CLINICAL DOCUMENTATION In the late 1990s, “To Err is Human” exposed the need to infuse a greater emphasis on quality and safety standards and measures in healthcare. Dacarba LLC has launched a proprietary healthcare quality analytics software, MDAR (Medical Diagnosis Accuracy Reporting), which paints an accurate and transparent picture of each patient’s comorbidities for providers and improves quality measurement. Our goal is to create an equal playing field across healthcare institutions, accurately reflect the quality of care provided and strengthen physician and hospital credibility. MODERN VALUE-BASED HEALTHCARE American healthcare is undergoing a transformation from consumption to value, with an ever-increasing emphasis on quality, safety and value-based payment. Quality performance metrics are used more and more to drive value-based payment and reputation for providers and hospitals. Healthcare systems across the nation desire to improve their overall rankings by accurately reflecting clinical quality and anticipate continued industrywide changes.
With the use of MDAR , our client was able to elevate their CMS ranking from 3 stars to 5 stars in 18 months
Revenue $2,300 Increase per Medicare high-risk patient $20M Annual incremental revenue gain $2.4M P4P penalty reductions
Mortality 47% Expected Medicare risk increase Acute myocardial infarction (AMI) mortality ranking increased from 77th percentile to
94th percentile Heart failure (HF) mortality ranking increased from 97th percentile to 99th percentile
Hospitals have been inundated with numerous and sometimes conflicting methodologies during the transformation from a fee-for-service program to a value-based program. Clinical documentation is the bridge between the care provided and quality measures. Thus, accurate clinical documentation is paramount. Documentation is often incomplete for the following reasons: omission of chronic conditions, missing diagnostic laboratory tests and vitals and evolving documentation policies. Accurately reflecting outcomes requires fully recording patient and treatment data, including any complications or comorbidities (CCs) and/or major complications or comorbidities (MCCs). Improved coding leads to more accurate patient classification and risk adjustment while optimizing quality reporting and reimbursement. As an added benefit, determining the correct Medicare diagnostic related groupings (DRGs) can help maximize revenue per encounter.
OUR SOLUTION A study supporting the creation of MDAR was conducted to understand how the methodology changes made by the Centers for Medicare and Medicaid Services (CMS) and U.S. News & World Report affected a hospital’s overall quality ranking. The hospital found that seemingly small differences in just one part of the reporting chain—the data source—can propagate through all the subsequent analyses, leading to problematic or discordant results in their rankings. It also found common measures across CMS, U.S News & World Report and other quality score organizations.
Reputational MDAR’s effect on reputation is significant by improving ratings and rankings across rating organizations. This improvement can lead to better recruitment and retention of talent while drawing in more patients and increasing market share.
The Tool MDAR focuses onmedical diagnosis accuracy by identifying CCs or MCCs for one or more of the chronic and acute conditions identified by Medicare as clinical areas of importance. A comprehensive dataset is generated daily and includes encounter data, laboratory, vitals, diagnoses, etc. with a relevant clinical lookback. Clinical variables are identified and analyzed for each condition to identify possible quality improvement. The Value of a Quality-Driven, Comorbidity Solution Quality is now the metric that drives overall performance. In order to effectively maximize quality ratings, hospitals must adopt the “It Takes a Village” mentality. Departments and teams that were siloed with singular missions must join and collaborate to elevate their facility and system’s quality performance. MDAR is a technology solution that can cultivate
collaboration to maximize value across the organization. MDAR can add value to financial, reputational and operational areas across a facility or system. Financial MDAR provides direct financial impact through Value-Based Purchasing and the Hospital Readmissions Reduction Program. Indirect benefits can be found through areas, such as contract negotiation and technology enablement, to allow growth without adding incremental cost. Optimized Quality Through improved coding, accurate risk adjusting and correct diagnosis grouping, hospitals are able to produce a more robust and true picture of their clinical outcomes. The MDAR application captures all current and prior quality data points and, through evidence-based algorithms, improves quality reporting and pay-for-performance reimbursements.
MDAR SOLUTION FEATURES • Web-Based Platform • Utilizes EMR • Record Flagging • Prioritized Patient Record List • Dashboard Capabilities • Improved Collaboration
Sean Clements Managing Partner Houston 713.237.4805 email@example.com
DALLAS • HOUSTON • NEW YORK CITY www.dacarba.com/Healthcare-Technology/Page 1 Page 2
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