Major database used to set hospital reimbursement has deep flaws

A major database used to determine hospital reimbursement contains glaring flaws, according to research from the Johns Hopkins University School of Medicine.

The Nationwide Inpatient Sample (NIS) critically underreports data on patients' weight and body mass, as well as their alcohol and tobacco use, states the research, published in the journal PLOS ONE.

The Centers for Medicare & Medicaid Services (CMS) uses NIS data to set reimbursement rates based on hospitals' risk for readmission or surgical complications. Using incorrect data could have a significant impact on reimbursement rates. The National Institutes of Health also uses the NIS to spot trends related to certain diseases, according to an announcement.

During hospital admission, patients are weighed, measured and asked about their drug and alcohol use. However, the NIS is based on billing data, and data such as obesity status and alcohol abuse generally are not reflected there.

The researchers found the discrepancy by comparing the NIS with data from the Behavioral Risk Factor Surveillance System (BRFSS), a federally sponsored telephone survey of more than 500,000 American adults about their health. The BRFSS questions include height, weight, as well as  tobacco and alcohol habits.

Many hospitals are substituting observation care for readmissions, even those that do not stand to lose money if they don't reduce their rates, recent research has found.

Meanwhile, the Medical Home Network (MHN) collaboration in Chicago has significantly reduced readmissions by using technology that provides real-time data across disparate entities such as hospitals and primary care practices. It enables providers and care teams to respond more quickly and make informed, coordinated care transitions.

To learn more:
- here's the study
- read the announcement

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