For hospitals, Marketscape Insights provides quality metrics broken out by several different clinical groupings, so you can precisely tailor your messaging. Use the table below to select the best grouping.
|Clinical Grouping||Description||Granularity||Best for|
|Trella Health Diagnostic Groupings||Patient volume, utilization, and quality metrics by ICD-10-CM Chapter for the primary diagnosis of the patient||Low||
High level discussions with the hospital on areas of opportunity and discussions on utilization percentages.
Patient volume and quality metrics by the Medical Severity-Diagnosis Related Group listed on the inpatient claim
|High||Clinical discussions with the hospital or physicians on how your programs align to a specific type of patient.|
|Readmission Penalty Group (RPG)||Patient volume and quality metrics by the Readmission Penalty Group for the primary diagnosis on the inpatient claim||Medium||Financial discussions with the hospital on how your organization can help them save money.|
|Patient volume and quality metrics by Bundled Payment for Care Improvement initiative grouping for the primary diagnosis on the inpatient claim||Medium||Clinical discussions with hospitals that are participating in BPCI or when one of your programs closely aligns to the BPCI grouping and it provides a helpful roll up of more granular MS-DRGs.|
See the Trella Health Diagnostic Groupings article for more information.
Complete list of BPCI Clinical Episodes of Care (48)
|The 48 BPCI Clinical Episodes of Care are listed in this table alphabetically. If you hover over a cell containing an episode name, a pop-up will show the related DRGs for that Episode.|
|Acute myocardial infarction||Combined anterior posterior spinal fusion||Major bowel||Percutaneous coronary intervention|
|Amputation||Complex non-Cervical spinal fusion||Major cardiovascular procedure||Red blood cell disorders|
|Atherosclerosis||Congestive heart failure||Major joint replacement of the lower extremity||Removal of orthopedic devices|
|Automatic implantable cardiac defibrillator generator or lead||Coronary artery bypass graft surgery||Major joint replacement of upper extremity||Renal failure|
|Back and neck except spinal fusion||Diabetes||Medical non-infectious orthopedic||Revision of the hip or knee|
|Cardiac arrhythmia||Esophagitis, gastroenteritis and other digestive disorders||Medical peripheral vascular disorders||Sepsis|
|Cardiac defibrillator||Double joint replacement of the lower extremity||Nutritional and metabolic disorders||Simple pneumonia and respiratory infections|
|Cardiac valve||Fractures femur and hip/pelvis||Other knee procedures||Spinal fusion (non-Cervical)|
|Cellulitis||Gastrointestinal hemorrhage||Other respiratory||Stroke|
|Cervical spinal fusion||Gastrointestinal obstruction||Other vascular surgery||Syncope and collapse|
|Chest pain||Hip and femur procedures except major joint||Pacemaker||Transient ischemia|
|Chronic obstructive pulmonary disease, bronchitis/asthmae||Lower extremity and humerus procedure except hip, foot, femur||Pacemaker Device replacement or revision||Urinary tract infection|
Source: CMS.GOV - https://innovation.cms.gov/initiatives/bundled-payments/