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Potential Health Disparities for Patients Leaving a Hospital AMA

Published on 

Wednesday, June 19, 2024

 | Coding 
 | Documentation 
 | OIG 

The OIG’s updates its Work Plan on their website monthly and they have indicated that their “work planning process is dynamic, and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues with the resources available.”

For June 2024, the OIG has added eleven items to their Work Plan. One of the items of interest for hospitals is titled Medicare Enrollees Leaving Hospitals Against Medical Advice. The OIG notes that “according to some academic researchers, the AMA designation indicates a higher risk that a patient experienced poor quality health care. The researchers also note that hospital stays coded with the AMA designation may be associated with increased patient morbidity and mortality percentage rates. In addition, the researchers note that historically medically underserved groups of patients are more likely than other groups to receive the AMA designation. The percentage rates that hospitals have been designating that Medicare enrollees left AMA have increased over the past three decades. This data brief will analyze the percentage rates and outcomes for enrollees that hospitals designate as left AMA as well as provide CMS and other stakeholders with information that can be used to address health disparities and improve enrollee outcomes.”

The OIG is expected to issue a report in FY 2025. In the meantime, I turned to our sister company, RealTime Medicare Data (RTMD) to learn about this group of Medicare beneficiaries in CY 2023. The RTMD database includes paid claims data for all fifty states and Washington D.C.

The following insights were pulled from all Medicare Fee-For-Service paid claims in calendar year 2023 with a discharge disposition code of “07” which stands for “left against medical advice or discontinued care.” 

All Claims with Discharge Disposition “07”

Volume: 72,370

Total Payment: $779,351,684.25

Average Payment: $10,769.14

ALOS: 3.054 Days

 

Surgical Claims with Discharge Disposition 07

Surgical Volume: 5,021

Total Payment: $134,587,109.49

Average Payment: $26,810.18

ALOS: 6.089

 

Top 5 MDCs by Surgical Volume

MDC 5: Circulatory System: 1,335 claims

MDC 8: Musculoskeletal System & Connective Tissue: 828 claims

MDC 18: Infectious & Parasitic Disease: 517 claims

MDC 6: Digestive System: 411 claims

MDC 11: Kidney & Urinary Tract: 363 claims

 

Top Surgical MS-DRG Group: MS-DRGs 853 and 854: Infectious & Parasitic Diseases with O.R. Procedures with and without MCC: 465 claims

 

Top 5 Provider States by Surgical Volume

California: 734 claims

Florida: 575 claims

Texas: 372 claims

New York: 354 Claims

Pennsylvania: 188 claims

 

Medical Claims with Discharge Disposition 07

Medical Volume: 67,349

Total Payment: $644,764,574.76

Average Payment: $9,573.48

ALOS: 2.82

 

Top 5 MDCs by Medical Volume:

MDC 5: Circulatory System: 13,664 claims

MDC 4: Respiratory System: 7,808 claims

MDC 1: Nervous System: 5,976 claims

MDC 6: Digestive System: 5,860 claims

MDC 18: Infectious & Parasitic Diseases: 5,692 claims

 

Top MS-DRG Pair: MS-DRGs 871 and 872: Septicemia or Severe Sepsis without MV >96 hours with and without MCC respectively: 5,320 claims

 

Top 5 Provider States by Medical Volume

California: 9,962 claims

Florida: 8,334 claims

New York: 5,595 claims

Texas: 5,330 claims

Pennsylvania: 2,334 claims

 

Social Determinants of Health and Discharge Disposition 07

As mentioned previously, “researchers note that historically medically underserved groups of patients are more likely than other groups to receive the AMA designation.”

 

Social determinants of health (SDOH) are the conditions in the environment where people are born, live, learn, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. ¹ For this reason, I also looked for claims with a Social Determinant of Health (SDOH) Z code listed as a secondary diagnosis.

 

Out of this group of claims where the beneficiary left AMA, 3,519 Z-Codes were listed as a secondary diagnosis. Note, there were claims where more than one Z code had been coded so this number does not represent 3,519 individual Medicare beneficiaries. That said, there were 2,354 unique claims where one of the homelessness Z-codes was on the claim and 24 unique claims where one of the inadequate housing Z-codes were on the claim.

 

Resource

U.S. Department of Health and Human Services: Office of Disease Prevention and Health Promotion: Health People 2030: Social Determinants of Health webpage: https://health.gov/healthypeople/priority-areas/social-determinants-health

Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.