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30-Day Readmission by DRG
Track HRRP-eligible readmissions (AMI, HF, pneumonia, COPD, CABG, THA/TKA) with LACE score discharge risk stratification. Calculate current penalty exposure before CMS finalizes its adjustment.
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CMS IPPS Quality Measures
MORT-30-AMI, MORT-30-HF, MORT-30-PN, and COMP-HIP-KNEE trended over rolling 12-month windows matching CMS measurement periods. Flag when measures approach penalty threshold.
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HCAHPS Domain Scores
Communication with nurses, communication with doctors, hospital environment, pain management, discharge information, and overall hospital rating — by unit, service line, and physician.
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OR Utilization Analytics
On-time case start rate, room turnover time, block utilization by surgeon and service line, case cancellation rate with reason code distribution. Identify which surgeons and blocks are underperforming.
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HAI Standardized Infection Ratios
CLABSI, CAUTI, MRSA bacteremia, and C.diff infection SIR by unit with NHSN risk adjustment. Statistical process control charts to detect emerging outbreaks before they become survey findings.
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ED Throughput Metrics
Door-to-provider time, LWBS (left without being seen) rate, and psychiatric boarding hours by shift, day of week, and month. Correlate boarding hours with inpatient census to identify root causes.
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Geometric Mean LOS vs. Expected
Case mix index trending alongside geometric mean LOS vs. CMS expected LOS by MS-DRG. Identify DRGs where actual LOS consistently exceeds expected — the primary driver of operating margin compression.
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Cost per Adjusted Discharge
Operating margin, cost per adjusted discharge, charity care and uncompensated care as percentage of net patient revenue — aligned to GAAP cost accounting methodology used in audited financial statements.
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Core Measures Compliance
Joint Commission Core Measures including VTE prophylaxis, glycemic control, perinatal care, and tobacco treatment. Track compliance by responsible provider and flag non-compliant cases within 24 hours.