Improving the mortality index by capturing patient acuity through interprofessional real-time documentation improvement in a single hospital system

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Background:The observed to expected mortality ratio is a standardized way for reporting inpatient mortality and is used as a measure for hospital quality rankings and Centers for Medicare & Medicaid Services value-based payments. The goal of this study is to describe a single institution's mortality index improvement initiative through improved documentation of patient severity.Methods:Data were prospectively collected October 2016 through May 2017 on patients discharged from the acute care surgery, open heart surgery, neurosurgery, and University Hospital East. Mortalities were reviewed by a multidisciplinary committee for missed coding opportunities. These captured codes were adjusted based on the Vizient risk-adjustment model for mortality and the observed to expected mortality ratio was calculated.Results:Every service reviewed showed improvement in the expected mortality rate. Additional coding opportunities were present in 55.6% of acute care surgery, 24.3% of neurosurgery, 18.3% of open heart surgery, and 35.3% of University Hospital East cases. A total of 70 codes were improved during the 8-month period. The acute care surgery service showed the most improvement, with a 0.45 improvement in the observed to expected mortality ratio, followed by neurosurgery, with 0.43 improvement.Conclusion:Institutional observed to expected mortality ratio can be improved by targeting high-acuity services and capturing coding opportunities, leading to improvement in value-based payments and rankings.

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