Johns Hopkin's study finds 'glaring' data flaws hurt hospital reimbursement

A study from Baltimore-based Johns Hopkins University School of Medicine found medical history gaps in Nationwide Inpatient Sample data have devastating effects on hospitals' economic health.

Published in PLOS ONE, the study reveals a dramatic underreporting of patient's alcohol and tobacco use, as well as weight and body mass numbers, according to researchers at Johns Hopkins.

Underreporting can have a significant impact on a hospital's bottom line. Missing data often results in inaccurate risk adjustments and health quality assessments, leading to unfair reimbursement from payers.

The study compared NIS data to information collected in the Behavioral Risk Factor Surveillance System — a federally sponsored telephone administered survey where more than 500,000 American adults answered questions about their health.

Overweight prevalence in the U.S. is 0.21 percent according to the NIS and 35.8 percent according to BRFSS data. Alcohol abuse affects 4.6 percent of the population in the NIS data compared to 18.3 percent in the BRFSS. Twelve percent reported tobacco use in the NIS data versus 20.1 percent in the BRFSS.

"A very high number patients are having their risk coded as lower than it actually is...When people are coding, they are coding the big-picture conditions," said Susan Hutfless, PhD, contributing author to the study. Critical information about patient weight, alcohol abuse and tobacco use included in the recorded medical history doesn't usually make it onto a hospital bill, which can have a devastating economic impact on hospitals that see the sickest patients.

Regarding long-term solutions to the information gaps, the study suggests "financial incentives in coding, publicly available information on items used to adjust for risk in the existing Medicare products, and random audits" could increase NIS data and billing accuracy.

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