Q&A: Understanding the risk adjustment index

Q: The risk adjustment index is still not very clear to me. What are indexed hospitalizations?

A: The index admission is defined as the hospitalization of a patient to an inpatient acute care facility, paid under the inpatient prospective payment system (IPPS) with a principal diagnosis of one of the applicable diagnoses or qualifying procedures determined by CMS and the patient is discharged alive. There are other criteria that also need to be met, including that the patient must be covered with fee-for-service Medicare for a full year prior to and during the admission, and must meet all the inclusion and exclusion criteria for the specific condition.

As for the risk adjustment piece of the puzzle, depending on which program you are referring to, CMS will risk-adjust for certain things such as a patient’s socioeconomic status, age, gender, and certain comorbidities documented during the admission and for the prior 12 months. Risk adjustment is based on the information collected during and including that 12-month period of time prior to the index admission. Any complications that occur during the index admission are excluded from risk adjustment, which makes it very important for the present on admission indicators to be accurate.

Editor’s Note: Sharme Brodie RN, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.

For additional information, check out these resources:

• Article: Risk adjustment and CDI: A natural evolution
• Article: Hierarchical CDI: Risk adjustment focus helps influence patient care
• ACDIS Radio: CDI and Risk Adjustment
• Sponsored webinar: Risk Adjustment and its Impacts to CDI and Coding Operations
• Boot Camp: Risk Adjustment Documentation and Coding Boot Camp