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. |
| MS-DRG |
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. |
|
BPCI |
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. |
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| 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/
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