Accuracy of Hospital Discharge Codes in Medicare Claims for Knee and Hip Replacement Patients. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Kim, Hyunjee; Grunditz, Jenny I.; Meath, Thomas H.A.; Quiñones, Ana R.; Ibrahim, Said A.; McConnell, K. John
• Is Part Of: Medical care. Volume 58:Issue 5(2020)
• Publication Date: 2020-05
• Subjects: administrative data uses -- health economics -- Medicare; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001290
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Background: Despite the importance of the hospital discharge destination field ("discharge code" hereafter) for research and payment reform, its accuracy is not well established. Objectives: The aim of this study was to examine the accuracy of discharge codes in Medicare claims. Data Sources: 2012–2015 Medicare claims of knee and hip replacement patients. Research Design: We identified patients' discharge location in claims and compared it with the discharge code. We also used a mixed-effects logistic regression to examine the association of patient and hospital characteristics with discharge code accuracy. Results: Approximately 9% of discharge codes were inaccurate. Long-term care hospital discharge codes had the lowest accuracy rate (41%), followed by acute care transfers (72%), inpatient rehabilitation facility (80%), and home discharges (83%). Most misclassifications occurred within 2 broad groups of postacute care settings: home-based and institutional care. The odds of inaccurate discharge codes were higher for Medicaid-enrolled patients and safety-net and low-volume hospitals. Conclusions: Inaccurate hospital discharge coding may have introduced bias in studies relying on these codes (eg, evaluations of Medicare bundled payment models). Inaccuracy was more common among Medicaid-enrolled patients and safety-net and low-volume hospitals, suggesting more potential bias in existing study findings pertaining to these patients and hospitals. Abstract : Supplemental Digital Content is available in the text.