General Questions & Comments

  • This topic has 2 replies, 1 voice, and was last updated 3 days, 5 hours ago by Erin Giovannetti.
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I have some questions on the CTI dashboard.

1) In the table of ER Visits and IP Visits: Do these include all ER/IP visits during the episode? If your episode includes index hospital costs, does this count of IP visits include the index hospitalization? The sum of ER/IP visits in the table is greater than the sum of the ER/IP visits in the month by month count. Can you explain how each is calculated and why they differ?

2) In the table labeled “Detailed Comparison”: The total number of episodes in the performance period does not always equal the total number of “Beneficiary Episodes” in the table “Beneficiary Summary.” The numbers are close but slightly higher in the “Detailed Comparison” table. Why are these numbers different?

3) In the table labeled “Detailed Comparison”: The total number of ER and IP claims episodes is different from the table above under “Beneficiary Summary” which lists total number of ER Visits and IP Visits? Why are these numbers different?

4) In the table labeled “Detailed Comparison”: This table lists episode counts by claim type. If your episode includes index hospital costs, should we assume the count of episodes with “Short Term Hospital” claims should equal the number of total Episodes?

5) In the table labeled “Detailed Comparison”: There is a bar chart that shows “average amount” by claim type. Can you clarify how this “average amount” is calculated in the performance period? In the baseline period the total average amount matches the PMPE, but in the performance period is significantly different.

6) In one CTI report we see the Mean Episode Payment is higher in the performance period compared to the baseline period. However when I look at the cumulative spend, the spend per unit time and the detailed comparison the performance period costs look lover than the baseline period. Can you explain how the numbers in these three figures (cumulative spend, spend per unit time, and detailed comparison) relate to the mean episode payment?

Thank you,
Erin

Hello Again,

Some additional question on the methodology for the CTI calculations.
Can you provide the actual calculation of how the baseline in calculated and how you are re-basing the baseline to reflect 21 rates?

Is the claim performance actual charges from the providers? Has the hospital portion been adjusted/standardized to rate order rates?

For both, baseline and claim performance , can you tell us what is the source data being utilized?

Thank You,
Erin

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  • This topic has 2 replies, 1 voice, and was last updated 3 days, 5 hours ago by Erin Giovannetti.