ArborMetrix defines clinical procedures and conditions based on specific CPT, ICD-9, and ICD-10 codes, not just financial DRGs. Clinical logic excludes unusual patients that can invalidate comparisons and undermine credibility with physicians.
Standardized prices for all services are calculated using reference fee schedules. This allows for accurate comparison of utilization patterns across providers by eliminating cost variation due solely to contractual payment rates or CMS adjustments. Standard pricing also facilitates analysis of utilization trends across years by factoring out annual price changes.
All claims associated with a patient’s condition or procedure are linked, including professional fees, readmissions, and post-acute care such as home health, rehab, and SNF. Episodes encompass any related services in the relevant 30- or 90-day window, aligning costs with bundled payments.
They provide an incomplete picture when tracking a patient’s course of care for a single procedure or condition. They base their analysis on inpatient claims only, ignoring data from pre-admission and post-discharge.
They fail to gain credibility with physicians due to lack of clinical granularity. Clinical depth is often limited to the discharge DRG.
They unfairly assess and compare hospital and physician performance with inadequate risk adjustment, or no risk-adjustment at all.
Break through the data clutter and obtain clinically relevant, scientifically robust performance information with:
Joe Kimura, MD, MPH
Chief Medical Officer, Atrius Health