The graphic displays provide “snapshot” comparisons to peers. The Comorbidity Index summarizes the disease burden in a practice. The bar indicates the range of values of the Comorbidity Index for the Specialty in the Area. The Risk Adjusted Cost Index (RACI) reflects the relative cost of care with adjustment for case-mix, severity, and comorbidity. The cost and utilization comparisons indicate the contribution various components make to differences in the RACI. Five additional graphic displays show what CPT/HCPCS codes appear in more of your high volume high cost episode groups.

The charts included with this report provide more detailed information to help you understand the factors that push the allowed cost for the episodes attributed to you above the expected cost. Five episode groups were selected to serve as illustrations. They are the five MEG/Severity/Comorbidity Group rows with the greatest numbers of episodes where the Total Cost exceeds the Total Expected Cost on the Summary Report. A report consisting of two sections is generated for each of the five.

1. Section 1 provides comparisons to peers on components of cost and utilization for inpatient and ambulatory services.
2. Section 2 shows what services (CPT and HCPCS codes) appear in your episodes compared to peers.

Download a copy of the Summary Report Guide and Definitions for additional information.

Note - all comparisons are made to specialty peers in the same geographic area on episodes in the same Medstat Episode Group at the same level of Severity and in the same Comorbidity Group.

SECTION 1

Components of Cost and Utilization

Allow Amt Per Epis Total: The average allowed amount per episode of care, for all facility and professional services that are included in an episode of care.

INPATIENT

Average Allowed Amount per Episode Admit: The average of the allowed cost for episodes attributed to you.
Admits per 100 Episodes: The number of acute inpatient admissions observed in these episodes per 100 episodes.
Days per 100 Episodes: The number of acute inpatient days observed in these episodes per 100 episodes.
Average Length of Stay: Acute Inpatient days divided by number of inpatient admissions.
Allowed Amount per Admit: Total allowed amount for all acute inpatient admissions divided by the number of inpatient admissions

AMBULATORY

Allow Amt Per Epis Amb Prof: Average allowed amount for ambulatory professional services.
Allow Amt Per Epis Amb Fac: Average allowed amount for ambulatory facility services.
Visits Per 100 Epis Amb Fac: Average number of ambulatory visits in an episode of care provided in facility, per 100 episodes of care.
Allow Amt Per Epis Amb Off: Average allowed amount for ambulatory professional services provided in an office setting.
Visits Per 100 Epis Amb Off: Average number of ambulatory professional visits in an episode of care provided in an office setting, per 100 episodes of care.
Allow Amt Per Epis Amb ER: Average allowed amount for ambulatory emergency room services.
Visits Per 100 Epis Amb ER: Average number of ambulatory emergency room facility visits included in an episode of care, per 100 episodes of care.
Allow Amt Per Epis Amb Lab: Average allowed amount per episode of care for ambulatory laboratory and pathology services included in an episode of care.
Svcs Per 100 Epis Amb Lab: Average number of ambulatory laboratory and pathology services included in an episode of care, per 100 episodes of care.
Allow Amt Per Epis Amb Rad: Average allowed amount, per episode of care, for ambulatory radiology and imaging services.
Svcs Per 100 Epis Amb Prof Rad: Average number of ambulatory professional radiology and imaging services included in an episode of care, per 100 episodes of care.

SECTION 2

CPT Level Detail

This section shows which CPT codes are used by the physician(s)/provider(s) compared to peers for episodes in this Medstat Episode Group at this level of Severity for patients in this Comorbidity Group. It provides perspective on the variability of the mix of professional services, imaging, and laboratory testing being done during these episodes of care. It shows where the CPT codes used by the physician(s)/provider(s) in the Solutions ID and the peer group converge or diverge. This section will indicate the percent of episodes in which a service is being provided for a given clinical condition (e.g. glycosylated hemoglobin in chronic episodes of Diabetes Mellitus) or the percent of episodes in which a more intensive service is used relative to peers (e.g. laparascopic cholecystectomy with intraoperative cholangiography in episodes of Cholecystitis and Cholelithiasis where peers perform laparascopic cholecystectomy without intraoperative cholangiography).

% of Episodes: The number of episodes in which a given CPT code appears divided by the number of episodes in this Medstat Episode Group/Severity/Comorbidity Group. If a CPT code appears more than once in an episode, the episode is counted one time.

Comparison is the number of episodes in which a given CPT code appears for specialty peers in the same geographic area for the same Medstat Episode Group at the same level of Severity and patients in the same Comorbidity Group divided by the number of episodes across the peer group.

Relative Cost represents the relative cost for that service within the following divisions of a standard fee schedule based on ranking from low to high -

• Procedures
• Evaluation & Management
• Lab services
• Imaging
• Drugs
• DME

Definitions of the following fields are the same as in the Summary Report Guide and Definitions.

$: lowest quintile of cost within division

$$: second quintile

$$$: middle quintile

$$$$: fourth quintile

$$$$$: highest cost services within division