How Sick Is Sick? Measuring Severity of Illness

The cover article in the October 1986 issue of hfm, "Measuring Severity: How Sick Is Sick? How Well Is Well?," discussed the growing need to measure severity of illness of hospitalized patients. "Numerous

Back then, the Severity of Illness Index manual was used to quantify severity of illness of hospital inpatients, but this manual sparked a number of criticisms, with concerns ranging from subjectivity of the dimensions and potential difficulty in administering the manual on a national scale. Concerns about subjectivity existed because raters were required to form judgments based on written principles rather than solely abstracting or counting explicit data elements. As a result, a second-generation system, the Computerized Severity Index, was introduced to better capture severity of illness.

Recently, the Centers for Medicare and Medicaid Services proposed the most significant revisions to the inpatient prospective payment system since its implementation in 1988. However, on Aug. 1, 3006, in the final rule for FY07, CMS backed away from a complete overhaul of the IPPS with severity adjustments. The rule provides for basing DRG weights on hospital costs rather than charges, beginning in FY07 and transitioning over a three-year period, and also will refine the current classification system to increase recognition of severity of illness by including the adjustment of 20 DRGs for patient severity. CMS has issued a contract for the evaluation of alternative severity adjustment systems to that proposed in the FY07 rule and has left the door open for implementation of a selected system in FY08.

CMS estimates the final rule provides an increase of $8.4, billion in Medicare payments to hospitals in FY07 and notes the limited impact on payments for specific DRGs. No DRG weight will decrease more than 5.4, percent in FY07, and 19 DRG weights will increase by more than 5 percent.