In the wake of last month's controversial release of Florida's hospital report card, nearly four-dozen hospitals are double-checking patient medical records to determine if miscoded diagnoses could have lowered their ratings.A spok esman for the Florida Hospital Association said undercoding the severity of illness of patients probably led to some hospitals' higher than expected mortality rates.A review by MODERN HEALTHCARE*indicated that 47 of 202 hospitals i n Florida registered higher than expected mortality rates in at least one of the eight medical areas reviewed by the state. Some hospitals received higher than expected mortality rates in multiple areas, the review showed.Florida i s the second state after Pennsylvania to release a report card on hospitals. The evaluation, which reviewed 1994 data, compares hospitals' prices, expected mortality rates and lengths of stay (March 4, p. 80)."As hospitals go back and assess their coding, and if the state makes some additional changes, we believe next year's report card will be more accurate," said Kim Streit, FHA vice president of information services.Streit said the problem for some hosp itals began in 1992 when Medicare began to allow hospitals to report nine medical codes per diagnosis-related group. The change, included in the UB-92 billing form, gave hospitals greater flexibility in reporting more severe illnes ses. Commercial payers also use the UB-92 billing form."Only four of the nine codes are used for billing purposes," Streit said. "Some hospitals continued to report within those four codes and didn't see a need to code for sever ity. Now that the state is using that data, they are going back and redoing their medical records."Three-hospital Memorial Health System in Ormond Beach, Fla., is one of the hospital groups that understated the severity of illness of its patients, said Clare Watson, system vice president of marketing and development."It is a very laborious process to go over thousands of medical records," Watson said. "But we will get more accurate information to the sta te about our hospital."Because of undercoding, one Memorial hospital scored an expected mortality rate in cardiac surgery of 1.15% but had an actual death rate of 4%, which is the national average, Watson said.State officials last week also said they are using the report card methodology to review hospitals in Florida in 1993 and will issue a three-year trend report in early fall."My concern is how you do a three-year risk-adjusted data report," Streit sa id. "If something changes at a hospital, how can you interpret that? Does that mean the hospital is going down the tubes? It can cause additional problems."
THE WEEK IN HEALTHCARE;QUALITY;FLA. HOSPITAL RATINGS CAUSE UPROAR
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