Case Loss Overview + Video

The Case Loss report shows where patients who initially received care at the targeted facility but subsequently received a procedure or service of interest at a different facility. A procedure or service of interest is defined by your codeset. Initial care is considered broadly, capturing any treatment or diagnosis received prior to the procedure or service of interest.

There is no guarantee that patients who ultimately received a procedure or service of interest elsewhere were first seen for the same conditions as the relevant treatment. The report examines the order in which any care was provided to these patients, and where it was provided along that patient’s journey.

The following charts show which facility ultimately delivered the procedures or services of interest. The count for each facility summarizes the total number and types of procedures or services of interest lost by the targeted facility, that were ultimately delivered by each listed facility. Notice also the amount of revenue lost, in the first graphic by DRG and in the second by facility. The third graphic shows the top physicians to whom cases were lost, along with lost revenue.

% Of Total Cases Lost

The first visual shows the breakdown of the cases lost by procedure or service of interest, as a percentage of the total cases lost.

DRGs

Facilities

Amount of revenue lost by facility along with the number of patients.

Physicians

The third graphic shows the top physicians to whom cases were lost, along with the number of patients and lost revenue.

• Use this report to understand if the targeted facility is able to engage the patient and encourage their patients to remain loyal to that facility for the entire continuum of care. Keeping patients, who initially sought out care from the facility (for any type of pre-service), fully engaged could have a significant lift on their volumes.
• Be sure to investigate if cases being lost to another facility are within the same health system affiliation. In these situations, the cases may not be truly lost as facilities with the same health system may specialize and intentionally refer patients between facilities or otherwise be designated as centers of excellence within their network.
• Facilities with high case loss may have opportunities to improve care coordination and patient communication or focus on physician referral development. High case loss may also be a result of not having access the right types of surgeons who excel at performing the procedure and services of interest. High case loss may also indicate a need for the targeted hospital to invest in additional technology to further differentiate the facility from the local competition.

But what if the billable amount loss in the case loss report doesn't seem to match the calculated amount by facility?

Considerations:

• The first number (case loss value) is calculated based on the reimbursements received by the focal facility for each DRG case lost.
• The case lost to each facility section is using the reimbursement received by that facility for the cases they gained. Therefore we don't expect the two numbers to be exactly the same given different reimbursement levels between facilities