News: Analysis suggests CMS policy change triggered a spike in reported SOI

A reported spike in severity of illness (SOI) in inpatient Medicare beneficiaries may, at first glance, seem to indicate a sicker population, a new analysis published in the Journal of the American Medical Association (JAMA) Network Open suggests that the increase may be a byproduct of CMS’ payment reforms in 2011 rather than a true change in patients’ conditions, Medscape Medical News reported.

For their analysis, Devraj Sukul, MD, and colleagues from the University of Michigan (Ann Arbor) Medical School in division of cardiovascular medicine studied 47,951,443 fee-for-service discharges at 2,850 hospitals between January 1, 2008, and August 31, 2015.

Sukul found that the expansion of coding secondary diagnoses significantly increased measured SOI among hospitalizations for all diagnoses. In 2011, CMS expanded the maximum number of secondary diagnosis codes providers could submit per claim from nine to 24. Not only does this expansion allow providers to more accurately depict their patients’ conditions, but those codes also helped with risk adjustment calculations and payment determinations, according to Medscape Medical News.

Sukul and fellow researchers also found that health information technology incentives were associated with a significant increase in condition categories for all diagnoses.

The authors say that although EHR capabilities may have allowed hospitals to better assess patient risk, they were also incentivized to increase patients’ SOI with the implementation of value-based payments and expanded secondary diagnosis code reporting.

According to their findings, the expanded secondary diagnosis code reporting was linked with a 18.4% change in condition categories for all diagnoses; the EHR incentives were associated with 0.0013% change in condition categories for all diagnoses, Medscape Medical News reported.

These findings, the authors wrote, suggest “that the increases in measured [SOI] more likely represent changes in hospital coding practices rather than actual changes in underlying patient severity.” They also suggest that CMS should identify better ways to assess a hospital’s performance and get a true picture of SOI by auditing secondary diagnoses coded by hospitals.

Editor’s note: To read Medscape Medical News’ coverage of this story, click here. To read the findings in JAMA Open Network, click here.