Data are only as good as collection procedures
Comparing hospitals based on complication rates may not be as cut and dried as it sounds. An individual hospital’s complication rates can be affected by how aggressive its medical records coders are, says Ralph Keill, MD, assistant administrator and medical director at Salinas Valley Hospital in Salinas, CA.
"The coders are trying to code aggressively to maximize revenue. That may look good for revenue, but it may not look so good when you’re comparing yourself to someone who doesn’t code as aggressively," he explains.
When Keill sees a high complication rate accompanied by average or below average length of stay (LOS) and charges, he gets suspicious and goes to the charts. Why? A high complication rate should be accompanied by higher-than-average LOS and charges.
In the case of the high complication rate for percutaneous transluminal coronary angioplasty (PTCA), data showed not a single mortality or case of a patient going to the operating room. Keill knew something was up.
"We looked at the charts and discovered that there were a lot of charts coded as accidental perforation or laceration of vessel."
Keill’s next stop the coders’ desks. "They said any time they saw the cardiologist mention a dissection, they coded it as an accidental perforation or laceration. But, a dissection sometimes is just the end point of a PTCA. Basically [the physician will] dilate the vessel until [he or she] starts seeing a dissection and then quit," Keill says. "Once we got the cardiologists and coders together and established the criteria under which we were going to code accidental perforation that is, if the vessel actually is perforated, if the patient bleeds and has to have a transfusion, or if the patient has to go to the OR then we saw a change in the reported complication rate."
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