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Responsible Provider of Inpatient Care

Technology #20170008

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License this Technology
Facility Use - Responsible Provider of Inpatient Care
$2,500.00
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Responsible Provider AlgorithmAccurate Medical Reporting
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Researchers
Levi Downs, MD
Chief Medical Officer, University of Minnesota Medical Center
External Link (www.virology.umn.edu)
Brady Alsaker, MN, RN
Health Informatics Consultant
Christy Swarthout
Director Clinical Quality Analytics at University of Minnesota Health
Managed By
Andrew Morrow
Technology Licensing Officer
Files and Attachments
Responsible Provider Attribution [PDF]
Instructions for Using the Software [DOCX]

Responsible Provider Algorithm for Inpatient Accounts

Uses Center for Medicaid Services Guidelines

A new reporting algorithm improves accuracy in assigning responsible provider data for inpatient hospital accounts. Following guidelines established by the Center for Medicaid Services (CMS), this algorithm helps coders adhere to federal and state rules and regulations while helping hospitals measure physician quality and performance. The algorithm is based on several components:

  • clinical note documentation with a weighted points system
  • account information assigned by coding professionals
  • procedural categories from the Healthcare Cost and Utilization Project (under the Agency for Healthcare Research and Quality)
  • data on provider types, titles and degrees
  • length of stay
  • providers’ hospital medical/surgical groups

Increased Physician Accuracy via Automation

Current methods of assigning providers of record to inpatient hospital accounts falter in many ways. Most notably, the most recent provider is often designated as the responsible provider, but that does not accurately reflect the physician who provided the most care, or even the most invasive care. Human coders may also lead to incorrect public reporting. The algorithm automates the process, using data already entered into the electronic health record system, and has potential for full automation as coding workflows become automated. Reducing human error by leveraging automation can increase reporting accuracy.

BENEFITS AND FEATURES:

  • Improved reporting accuracy; less prone to errors
  • Numerous data points/components
  • Weighted point system
  • Partial automation with potential for full automation

APPLICATIONS:

  • Assigning responsible provider data for inpatient hospital accounts
  • Physician quality measures and performance reviews

Phase of Development Available - please see the link at the right for the "Instructions for Using the Software".