SHM Converge Scientific Abstract ePoster Gallery-Trends in High Severity Billing for Hospitalized Medicare Beneficiaries Treated by Hospitalists vs. Non-Hospitalists

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This study examined trends in high-severity billing for hospitalized Medicare beneficiaries from 2009 to 2018, comparing hospitalists with non-hospitalists. Using Medicare Part A and B fee-for-service claims, the authors defined hospitalists as physicians in internal medicine, general practice, family practice, or hospitalist specialties whose inpatient evaluation and management claims made up at least 90% of annual claims. They analyzed high-severity coding for initial, subsequent, and discharge hospital encounters, adjusting for patient characteristics, comorbidities, diagnosis-related groups, and hospital fixed effects.<br /><br />The main finding was that hospitalists consistently coded a higher proportion of encounters as high severity than non-hospitalists, and these differences widened over time. For initial encounters, hospitalists started at 69.9% in 2009 and ended at 69.1% in 2018, while non-hospitalists declined from 63.0% to 58.4%. For subsequent encounters, hospitalists increased from 32.9% to 39.9%, compared with 30.1% to 33.6% for non-hospitalists. The largest gap was in discharge encounters: hospitalists rose from 48.2% to 70.6%, while non-hospitalists increased from 34.2% to 45.3%.<br /><br />The authors suggest these differences are unlikely to be explained by large differences in patient complexity. Possible reasons include health reform increasing attention to discharge coordination and outcomes, which may lead to more time-intensive discharge billing, and compensation models tied to productivity, which may encourage more accurate or more aggressive coding. They also note that the growing number of hospitalists may be contributing to rising hospital care costs nationally.<br /><br />Limitations include the observational design, lack of information on physician compensation or RVU incentives, and restriction to Medicare beneficiaries, limiting generalizability. The study concludes that future research is needed to identify the drivers of high-intensity billing and develop strategies to reduce potential upcoding.

Asset Subtitle

Agustina Saenz

Meta Tag

Author List Agustina Saenz, E. John Orav, Jessica Phelan, Jose F. Figueroa, Yusuke Tsugawa

Category Research

Concept Study Purpose

Concept Hospitalist

Concept High-Intensity Billing

Concept High-Severity Billing

Concept Study Design

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Agustina Saenz

Track Other

Keywords

hospitalists

high-severity billing

Medicare beneficiaries

hospital encounters

coding trends

inpatient claims

upcoding

discharge encounters

healthcare costs

observational study

Study Purpose

Hospitalist

High-Intensity Billing

High-Severity Billing

Study Design