Grouping types

When setting the parameters for your profile, you have the option to select the grouping type. The grouping type defines how the benchmark calculations is risk-adjusted. For more information about benchmark risk adjustments, check out Benchmark calculations. The available grouping type options are different for a few of the profile types follow.

Inpatient encounter options

These Grouping Type options apply to internal inpatient encounters, including the following Profile Types:

  • Internal Encounter - Inpatient
  • Internal - Physician
  • Internal - Department
  • Internal - Facility
  • Dynamic - Role
  • Dynamic - Physician Specialty at Hospital
  • Internal Encounter - Inpatient and Observation

For all Profile Types (except Peer Group, Emergency Department, Outpatient Diagnostics, ASC, and All Encounter Types), your Grouping Type options include APR-DRG, MS-DRG, and Client MS-DRG (if your facility provides MS-DRG with your data).

For some history and uses of groupers, review the APR-DRGs and MS-DRGs webinar from Fall 2016 on our Webinars page.

For specific information about each grouping type, select the following links; or, for a comparison summary, review MS-DRGs vs APR-DRGs.

  • APR-DRG
    • All-Patient Refined Diagnosis Related Group
    • Adjusts for encounter severity at the APR-DRG SOI or ROM level
    • We typically recommend using APR-DRG grouping because the 4 levels of ROM and SOI for each APR-DRG allow for a more precise benchmark adjustment.
  • MS-DRG/Client MS-DRG
    • Medicare Severity Diagnosis Related Group
    • MS-DRGs are associated into MS-DRG clusters; encounter severity is adjusted to the MS-DRG level
    • There is typically no difference between the MS-DRG and Client MS-DRG assignments, and severity adjustments are calculated the same for both.
    • You might prefer to use MS-DRG grouping if you are analyzing Medicare reimbursements, a Medicare population, or a specific sub-population that is better classified by MS-DRGs.

Emergency Department encounter options

For the profile type Internal Encounter - Emergency Department, your Emergency Department grouping types include:

  • Principal APC Code
  • Principal ICD Diagnosis Code
  • Level of Care

Outpatient Diagnostics and ASC encounter options

For the profile type Internal Encounter - Outpatient Diagnostics and ASC, your Outpatient Diagnostic and ASC grouping types include:

  • Principal APC Code
  • Principal ICD Procedure Code
  • Principal CPT/HCPCS Code

Peer groups

Because the peer group data are used to calculate benchmarks based upon the grouping type you selected for your profile of interest, there is no grouping type option for the peer group profile type.