Beyond Severity of Illness: Evaluating Differences in Patient Intensity and Complexity for Valid Assessment of Medical Practice Pattern Variation

A growing body of research indicates that severity-adjustment alone does not adequately explain legitimate differences in charges, costs, and length of stays within diagnosis related groups (DRGs) across providers. In order to validly compare resource utilization across providers, other patient attributes such as age and the number of complications and comorbidities (CCs) managed during the patient stay must be accounted for to address the full range of patient characteristics that affect the need for varying levels of resource consumption. In an era of unprecedented public scrutiny and consumerism the need to more fully adjust for differences in patient characteristics across providers could not be greater. In response to this need, a Severity, Intensity, and Complexity (SIC) model has been developed which integrates leading severity measurement techniques with specific patient age cohorts and CC clusters to account for differences in patient intensity and complexity. The calibration and construction of the SIC model was based on a modified version of the CMS