Acute Care Hospital · MS-DRG

KaraDayDemo Houston Methodist

Upstream hospital admissions for residents who later transferred to KaraDayDemo's downstream facilities (SNF · HH · Hospice). MS-DRG drives per-discharge payment; LOS variance and 30-day readmission risk drive HRRP exposure (up to 3% of Medicare payments).

Active admissions

12

upstream pipeline

DRG revenue

$82,161

avg $6,847/discharge

High readmit risk

7

HRRP penalty exposure

LOS outliers

1

above benchmark

Top DRG mix

DRG 194

Simple pneumonia & pleurisy with CC

×9

DRG 291

Heart failure & shock with MCC

×1

DRG 871

Septicemia or severe sepsis with MCC

×1

DRG 292

Heart failure & shock with CC

×1

Admissions roster (sorted by readmission risk)

PatientAdmit / DischargeDRGSeverityLOSPaymentReadmit riskDispo

Ruben Delacroix

Pneumonia, unspecified organism

2026-04-23

2026-04-27

194

Simple pneumonia & pleurisy with CC

CC4d / 3.4$6,158highSNF

Patricia Delacroix

Congestive heart failure, unspecified, acute exacerbation requiring skilled nursing facility care

2026-04-18

2026-04-24

291

Heart failure & shock with MCC

MCC6d / 4.1$9,293highSNF

Mei-Ling Tsutsumi

Pneumonia, unspecified organism

2026-04-17

2026-04-21

194

Simple pneumonia & pleurisy with CC

CC4d / 3.4$6,158highHome Health

James Okafor

Pneumonia, unspecified organism

2026-04-16

2026-04-20

194

Simple pneumonia & pleurisy with CC

CC4d / 3.4$6,158highSNF

Sylvia Okafor

Sequelae of cerebral infarction with residual neurological deficits driving skilled nursing facility stay

2026-04-08

2026-04-13

871

Septicemia or severe sepsis with MCC

MCC5d / 4.7$11,645highSNF

Darnell Washington

Congestive heart failure, unspecified, exacerbation requiring skilled nursing facility care

2026-04-05

2026-04-09

292

Heart failure & shock with CC

CC4d / 3.4$5,801highSNF

James Okafor

Pneumonia, unspecified organism

2026-04-05

2026-04-09

194

Simple pneumonia & pleurisy with CC

CC4d / 3.4$6,158highHome

Shirley Tompkins

Pneumonia, unspecified organism

2026-04-22

2026-04-26

194

Simple pneumonia & pleurisy with CC

CC4d / 3.4$6,158moderateHome Health

Linda Svensson

Pneumonia, unspecified organism

2026-04-20

2026-04-24

194

Simple pneumonia & pleurisy with CC

CC4d / 3.4$6,158moderateHome Health

James Okafor

Pneumonia, unspecified organism

2026-04-14

2026-04-18

194

Simple pneumonia & pleurisy with CC

CC4d / 3.4$6,158moderateHome Health

Linda Bergstrom

Pneumonia, unspecified organism

2026-04-14

2026-04-18

194

Simple pneumonia & pleurisy with CC

CC4d / 3.4$6,158moderateHome Health

Loretta Simmons

Pneumonia, unspecified organism

2026-04-05

2026-04-09

194

Simple pneumonia & pleurisy with CC

CC4d / 3.4$6,158moderateHome Health

MS-DRG, LOS classification, and 30-day readmission risk are computed deterministically by lib/verticals/acute-hospital. v0.1 covers ~25 representative DRGs (the post-acute pipeline subset); production plugs in CMS's full ~750-row MS-DRG table. IPPS base rate FY2024 national; production applies wage index + IME/DSH + outlier policies.