Area 6: DRG Distribution — Case Mix & Complexity

Unique DRGs

All MS-DRG classifications

Most Common DRG

DRG 392

Esophagitis/GI (14 enc)

Highest DRG Weight

2.05

Major Joint Replacement (470)

Avg Collection Rate

40.5%

Paid / Billed across all DRGs

Surgical DRGs

2 of 15

DRG 470 & 418 (22 encounters)

High Severity (Lv3)

28 enc

3 DRGs: Sepsis, Pneumonia, HF

Key Findings from DRG Analysis

LOS Overrun Alert: Laparoscopic Cholecystectomy (DRG 418) actual LOS is 5.5 days vs 3.0 expected (+2.5 days variance). Syncope (312) also runs 1.7 days over benchmark. These represent opportunities for care pathway optimization.
Efficiency Wins: Heart Failure w MCC (291) runs 1.85 days under benchmark, Pneumonia w MCC (193) is 1.64 days under, and Renal Failure (683) is 1.55 days under expected LOS. However, short stays should be validated against readmission rates.
Case Mix: Dominated by medical DRGs (85% of encounters). Average DRG weight of ~1.10 indicates moderate complexity. Digestive and Kidney/UT conditions are most common MDC categories.

Medical vs Surgical DRG Split

Metric	Medical	Surgical
Encounters	128	22
Avg DRG Weight	1.03	1.60
Avg Billed	$59K	$64K
Avg LOS	3.6 days	4.8 days

Severity Level Distribution

Level	Enc	Avg Billed	Avg LOS
Level 1 (Low)	47	$57K	3.8 days
Level 2 (Moderate)	75	$63K	3.8 days
Level 3 (High)	28	$56K	3.9 days

DRG Performance Detail — LOS Variance & Financial Analysis

DRG	Description	MDC	Weight	Severity	Type	Enc	Expected LOS	Actual LOS	Variance	Avg Billed	Avg Paid	Collection %

Area 6: DRG Distribution — Case Mix & Complexity

Key Findings from DRG Analysis

DRG Volume Ranking

LOS Variance: Actual vs Expected (Days)

Medical vs Surgical DRG Split

Severity Level Distribution

DRG Weight vs Avg Billed Amount

MDC (Major Diagnostic Category) Distribution

DRG Volume by Year (Top 8 DRGs)

DRG Performance Detail — LOS Variance & Financial Analysis