An urgent issue: How admit type can skew quality metrics

Listen to the episode here.

I’m recently back from the 2025 ACDIS national conference, and as usual flush with the latest in CDI trends, education, and breaking news. And right at the top of my takeaways is a seemingly innocuous classification with big ramifications: admit type.

What makes this a big deal? Some hospitals appear to be playing a bit fast and loose with guidance from the National Uniform Billing Committee (NUBC) in order to classify surgical admits as “urgent” rather than the more accurate “elective.” Doing so removes them from certain PSIs that negatively impact quality metrics and indirect revenue.

My guest is Penny Jefferson, manager of clinical documentation integrity at UC Davis. Penny co-presented the session with Cheryl Ericson at the ACDIS conference. On this show we discuss:

• What is admit type, why is it important, and common misunderstandings (admit type is very different than admit status–IP/OP/observation)
• Who is the NUBC, and what are the current rules as they stand around elective, urgent, and emergent?
• Compelling data—deidentified, but real—presented at ACDIS that shows what appears to be clear gaming by some healthcare organizations of the assignment of admit type, specifically opting for urgent over elective
• The dramatic impact this seemingly small change can have on quality scores: Reclassifying an elective procedure as urgent effectively circumvents PSI exclusions, allowing the case to be excluded from elective-only quality measures, such as PSI 10, 11, or 13.
• Possible solutions including Penny’s ongoing work with the NUBC and request for additional rigor
• Optimal way to ensure admit type accuracy in the current climate, from use of coding or CDI staff to additional training for admission staff
• Why is her boss Tami Gomez so awesome, and Penny’s selection for the Off the Record Spotify playlist

For additional reading

• Inconsistent ‘Admit Type’ Reporting May Inflate Hospital Quality Scores, Nina Youngstrom/Report on Medicare Compliance: https://compliancecosmos.org/inconsistent-admit-type-reporting-may-inflate-hospital-quality-scores