| V1261 - Personal history of pneumonia (recurrent) - as a primary or secondary diagnosis code | ||
|---|---|---|
| OUTCOMES | ||
| Avg. LOS | ||
| Readmission Rate (%) | ||
| Unplanned Readmission Rate (%) | 17.2 | |
| Mortality Rate (%) | ||
| SNF Discharge Rate (%) | ||
| Home Discharge Rate (%) | ||
| PAYMENTS AND CHARGES | ||
| Total Medicare Payments | ||
| Payment Per Day | ||
| Payment Per Hospitalization | ||
| Total Medicare Charges | ||
| Avg. Charges | ||
| MARKET SIZING & INCIDENCE RATES | ||
| Total National Projected Hospitalizations - Annualized (Present on Admission - All) | ||
| Total Medicare Hospitalizations - Oct 2015 to Sep 2018 (Present on Admission - All) | ||
| Total National Projected Hospitalizations - Annualized (Present on Admission - Yes) | ||
| Total Medicare Hospitalizations - Oct 2015 to Sep 2018 (Present on Admission - Yes) | ||
| Total National Projected Hospitalizations - Annualized (Present on Admission - Not Y) | ||
| Total Medicare Hospitalizations - Oct 2015 to Sep 2018 (Present on Admission - Not Y) | ||
| Total Medicare Hospitalizations after Exclusion | ||
| DRG 871: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 194: SIMPLE PNEUMONIA AND PLEURISY WITH COMPLICATION OR COMORBIDITY (CC) | DRG 190: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 191: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH COMPLICATION OR COMORBIDITY (CC) | DRG 189: PULMONARY EDEMA AND RESPIRATORY FAILURE | |
|---|---|---|---|---|---|
| Total Hospitalizations at DRG | 901,552 | ||||
| Total Hospitalizations with ICD V1261 - Personal history of pneumonia (recurrent) | 10,935 | ||||
| DRG Share of Total Hospitalizations | 3.95 | ||||
| % of Total ICD V1261 - Personal history of pneumonia (recurrent) in DRG | 6.38 | ||||
| Avg LOS at DRG | 6.79 | ||||
| Avg LOS with ICD V1261 - Personal history of pneumonia (recurrent) | 5.86 | ||||
| Readmission Rate at DRG | 25.38 | ||||
| Readmission Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 25.96 | ||||
| Unplanned Readmission Rate at DRG | 17.1 | ||||
| Unplanned Readmission Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 19.61 | ||||
| Total Medicare payments at DRG | $11,142,976,193 | ||||
| Total Medicare payments with ICD V1261 - Personal history of pneumonia (recurrent) | $129,787,818 | ||||
| Total Medicare payment per Day at DRG | $1,821 | ||||
| Total Medicare payment per Day with ICD V1261 - Personal history of pneumonia (recurrent) | $2,025 | ||||
| Total Medicare payment per Hospitalization at DRG | $12,360 | ||||
| Total Medicare payment per Hospitalization with ICD V1261 - Personal history of pneumonia (recurrent) | $11,869 | ||||
| Total Medicare Charges at DRG | $48,288,426,708 | ||||
| Total Medicare Charges with ICD V1261 - Personal history of pneumonia (recurrent) | $484,146,849 | ||||
| Avg Charges at DRG | $53,561 | ||||
| Avg Charges with ICD V1261 - Personal history of pneumonia (recurrent) | $44,275 | ||||
| Mortality Rate at DRG | 15.16 | ||||
| Mortality Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 11.61 | ||||
| SNF Discharge Rate at DRG | 28.41 | ||||
| SNF Discharge Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 26.81 | ||||
| Home Discharge Rate at DRG | 23.21 | ||||
| Home Discharge Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 29.14 |
| DRG 193: SIMPLE PNEUMONIA AND PLEURISY WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 291: HEART FAILURE AND SHOCK WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 945: REHABILITATION WITH COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 292: HEART FAILURE AND SHOCK WITH COMPLICATION OR COMORBIDITY (CC) | DRG 177: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) | |
|---|---|---|---|---|---|
| Total Hospitalizations at DRG | 296,720 | ||||
| Total Hospitalizations with ICD V1261 - Personal history of pneumonia (recurrent) | 5,003 | ||||
| DRG Share of Total Hospitalizations | 1.3 | ||||
| % of Total ICD V1261 - Personal history of pneumonia (recurrent) in DRG | 2.92 | ||||
| Avg LOS at DRG | 5.98 | ||||
| Avg LOS with ICD V1261 - Personal history of pneumonia (recurrent) | 5.56 | ||||
| Readmission Rate at DRG | 24.04 | ||||
| Readmission Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 26.14 | ||||
| Unplanned Readmission Rate at DRG | 17.42 | ||||
| Unplanned Readmission Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 19.37 | ||||
| Total Medicare payments at DRG | $2,681,981,318 | ||||
| Total Medicare payments with ICD V1261 - Personal history of pneumonia (recurrent) | $44,572,672 | ||||
| Total Medicare payment per Day at DRG | $1,513 | ||||
| Total Medicare payment per Day with ICD V1261 - Personal history of pneumonia (recurrent) | $1,601 | ||||
| Total Medicare payment per Hospitalization at DRG | $9,039 | ||||
| Total Medicare payment per Hospitalization with ICD V1261 - Personal history of pneumonia (recurrent) | $8,909 | ||||
| Total Medicare Charges at DRG | $11,896,768,371 | ||||
| Total Medicare Charges with ICD V1261 - Personal history of pneumonia (recurrent) | $185,750,967 | ||||
| Avg Charges at DRG | $40,094 | ||||
| Avg Charges with ICD V1261 - Personal history of pneumonia (recurrent) | $37,128 | ||||
| Mortality Rate at DRG | 5.39 | ||||
| Mortality Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 4.44 | ||||
| SNF Discharge Rate at DRG | 23.54 | ||||
| SNF Discharge Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 21.77 | ||||
| Home Discharge Rate at DRG | 38.6 | ||||
| Home Discharge Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 41.58 |
| DRG 470: MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 178: RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH COMPLICATION OR COMORBIDITY (CC) | DRG 192: CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 690: KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 392: ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) | |
|---|---|---|---|---|---|
| Total Hospitalizations at DRG | 939,378 | ||||
| Total Hospitalizations with ICD V1261 - Personal history of pneumonia (recurrent) | 3,673 | ||||
| DRG Share of Total Hospitalizations | 4.11 | ||||
| % of Total ICD V1261 - Personal history of pneumonia (recurrent) in DRG | 2.14 | ||||
| Avg LOS at DRG | 3.12 | ||||
| Avg LOS with ICD V1261 - Personal history of pneumonia (recurrent) | 3.24 | ||||
| Readmission Rate at DRG | 12.54 | ||||
| Readmission Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 15.11 | ||||
| Unplanned Readmission Rate at DRG | 3.52 | ||||
| Unplanned Readmission Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 4.83 | ||||
| Total Medicare payments at DRG | $11,301,359,598 | ||||
| Total Medicare payments with ICD V1261 - Personal history of pneumonia (recurrent) | $44,599,130 | ||||
| Total Medicare payment per Day at DRG | $3,853 | ||||
| Total Medicare payment per Day with ICD V1261 - Personal history of pneumonia (recurrent) | $3,753 | ||||
| Total Medicare payment per Hospitalization at DRG | $12,031 | ||||
| Total Medicare payment per Hospitalization with ICD V1261 - Personal history of pneumonia (recurrent) | $12,142 | ||||
| Total Medicare Charges at DRG | $51,993,364,479 | ||||
| Total Medicare Charges with ICD V1261 - Personal history of pneumonia (recurrent) | $199,060,788 | ||||
| Avg Charges at DRG | $55,349 | ||||
| Avg Charges with ICD V1261 - Personal history of pneumonia (recurrent) | $54,196 | ||||
| Mortality Rate at DRG | 0.07 | ||||
| Mortality Rate with ICD V1261 - Personal history of pneumonia (recurrent) | NA | ||||
| SNF Discharge Rate at DRG | 32.49 | ||||
| SNF Discharge Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 36.13 | ||||
| Home Discharge Rate at DRG | 21.06 | ||||
| Home Discharge Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 18.87 |
| DRG 872: SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 195: SIMPLE PNEUMONIA AND PLEURISY WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) | DRG 683: RENAL FAILURE WITH COMPLICATION OR COMORBIDITY (CC) | DRG 208: RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS | DRG 885: PSYCHOSES | |
|---|---|---|---|---|---|
| Total Hospitalizations at DRG | 285,530 | ||||
| Total Hospitalizations with ICD V1261 - Personal history of pneumonia (recurrent) | 2,258 | ||||
| DRG Share of Total Hospitalizations | 1.25 | ||||
| % of Total ICD V1261 - Personal history of pneumonia (recurrent) in DRG | 1.32 | ||||
| Avg LOS at DRG | 4.72 | ||||
| Avg LOS with ICD V1261 - Personal history of pneumonia (recurrent) | 4.56 | ||||
| Readmission Rate at DRG | 18.55 | ||||
| Readmission Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 22.36 | ||||
| Unplanned Readmission Rate at DRG | 12.87 | ||||
| Unplanned Readmission Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 16.74 | ||||
| Total Medicare payments at DRG | $1,922,582,097 | ||||
| Total Medicare payments with ICD V1261 - Personal history of pneumonia (recurrent) | $15,091,628 | ||||
| Total Medicare payment per Day at DRG | $1,427 | ||||
| Total Medicare payment per Day with ICD V1261 - Personal history of pneumonia (recurrent) | $1,467 | ||||
| Total Medicare payment per Hospitalization at DRG | $6,733 | ||||
| Total Medicare payment per Hospitalization with ICD V1261 - Personal history of pneumonia (recurrent) | $6,684 | ||||
| Total Medicare Charges at DRG | $8,696,353,387 | ||||
| Total Medicare Charges with ICD V1261 - Personal history of pneumonia (recurrent) | $66,464,757 | ||||
| Avg Charges at DRG | $30,457 | ||||
| Avg Charges with ICD V1261 - Personal history of pneumonia (recurrent) | $29,435 | ||||
| Mortality Rate at DRG | 2.4 | ||||
| Mortality Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 2.35 | ||||
| SNF Discharge Rate at DRG | 23.54 | ||||
| SNF Discharge Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 25.78 | ||||
| Home Discharge Rate at DRG | 44.6 | ||||
| Home Discharge Rate with ICD V1261 - Personal history of pneumonia (recurrent) | 37.47 |
| Hospital Name | Address | City | State | Zip Code | Total Hospitalizations ( Jan 2013 to Dec 2014 ) |
|---|---|---|---|---|---|
| COVENANT MEDICAL CENTER | 1447 N HARRISON ST | SAGINAW | MI | 48602 | 745 |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON | 3000 NORTH I 35 | DENTON | TX | 76201 | 727 |
| RIDDLE MEMORIAL HOSPITAL | 1068 W BALTIMORE PIKE | MEDIA | PA | 19063 | 726 |
| Physician Name | Address | City | State | Zip Code | Total Hospitalizations ( Jan 2013 to Dec 2014 ) |
|---|---|---|---|---|---|
| Dr. MUTHU S. KRISHNAN | 1191 HIGHWAY KK | OSAGE BEACH | MO | 65065 | 54 |
| Dr. KURT E. JACOBSON | 6262 VETERANS PKWY | COLUMBUS | GA | 31909 | 43 |
| Dr. CHETAN MALHOTRA | 575 BROADWAY | MASSAPEQUA | NY | 11758 | 38 |
| Physician Name | Address | City | State | Zip Code | Total Hospitalizations ( Jan 2013 to Dec 2014 ) |
|---|---|---|---|---|---|
| Dr. MICHAEL W HENNIGAN | 1847 FLORIDA AVE | PANAMA CITY | FL | 32405 | 120 |
| Dr. PATRICK W. ONEIL | 54 HOSPITAL DR | OSAGE BEACH | MO | 65065 | 118 |
| Dr. DWIGHT LAWRENCE BAILEY | 143 W MAIN ST | LEBANON | VA | 24266 | 114 |