# Professional review guide for the RHIA and RHIT Examination 2011 Edition

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Health Statistics and Research

### Sandy Beach Hospital reports 1,652 discharges for September. The infection control report documents 21 nosocomial infections and 27 community-acquired infections for the same month. What is the community-acquired infection rate? A. 1.3 B. 1.4 C. 1.6 D. 2.9

C (27 × 100) / 1,652 = 1.6%

### Physicians at South Seas Clinic are expected to see six patients per hour, on average. The physicians with the highest productivity each week are exempted from on-call responsibilities for the weekend. Which physician will get the weekend off this week? SOUTH SEAS CLINIC PHYSICIAN PRODUCTIVITY Week 1 January 2010 PHYSICIAN NAME NUMBER OF HOURS WORKED NUMBER OF PATIENTS SEEN Robinson 32 185 Beasley 30 161 Hiltz 35 200 Wolf 26 157 A. Robinson C. Hiltz B. Beasley D. Wolf

D Calculate the answer as follows:
PHYSICIAN
NAME NUMBER OF
HOURS WORKED NUMBER OF
PATIENTS SEEN NUMBER OF PATIENTS SEEN PER
HOUR WORKED
Robinson 32 1 85 1 85/32 = 5.78
Beasley 30 1 61 1 61 /30 = 5.37
Hiltz 35 200 200/35 = 5.71
Wolf 26 1 57 1 57/26 = 6.04

### If there are 150,000 medical records and the Health Information Department receives 3,545 requests for records in a week, what percentage of the records are requested weekly? A. 2.4% B. 3.5% C. 4.6% D. 5.1%

A 3,545 requested records × 100 / 150,000 total records = 354,500/150,000 = 2.36 = 2.4%.

D

### You are choosing restaurants where you might eat while you are in Chicago at the AHIMA Leadership Conference. You have collected the following information about four possible lunch restaurants that are all located within easy walking distance of the meeting site. The data is displayed below: RESTAURANT NAME MEAN LUNCH COST STANDARD DEVIATION Bon Appetite \$8.00 0.75 Mario's \$7.50 1 Au Courant \$9.00 1.25 The Windy City Grill \$7.50 1.5 You want to stay within the reimbursement rate allowed by your Component State Association, so it is important to you that you have at least a 95% chance of eating a lunch that costs no more than \$10.00. Therefore, when lunchtime comes, you head to A. Bon Appetite or Mario's. B. Mario's or Au Courant. C. Au Courant or The Windy City Grill. D. The Windy City Grill or Bon Appetite.

A CALCULATIONS: 95% of the observations fall within two standard deviations of the mean, so the cost of a lunch at Bon Appetite will be between \$6.50
[8 - (2 × 0.75)] and \$9.50 [8 + (2 × 0.75)].
Lunch at Mario's will be between \$5.50 [7.5 - (2 × 1)] and \$9.50 [7.5 + (2 × 1)].
Lunch at Au Courant will cost too much [\$9 + (2 × 1.25) = \$11.50].
As will the Windy City Grill [\$7.50 (2 × 1.5) = \$10.50].

B

A

C Calculations:

D

C

D

B

### Office Visit ID Number Minutes with the Physician Physician 508-123 5 Robinson 508-124 9 Robinson 508-125 8 Beasley 508-126 12 Wolf 508-127 6 Beasley 508-128 7 Beasley 508-129 5 Wolf 508-130 10 Baumstark 508-131 7 Baumstark 508-132 9 Robinson 508-133 11 Wolf 13. The mean number of minutes with the physician (considering all physicians) is A. 7 minutes. B. 8 minutes. C. 8.4 minutes. D. 9 minutes.

B Calculation: 5 + 9 + 8 + 12 + 6 + 7 + 5 + 10 + 7 + 9 + 11 = 89/11 = 8.09

### Office Visit ID Number Minutes with the Physician Physician 508-123 5 Robinson 508-124 9 Robinson 508-125 8 Beasley 508-126 12 Wolf 508-127 6 Beasley 508-128 7 Beasley 508-129 5 Wolf 508-130 10 Baumstark 508-131 7 Baumstark 508-132 9 Robinson 508-133 11 Wolf 14. Which physician spent the longest average time with patients on that day? A. Beasley B. Wolf C. Baumstark D. Robinson

B Calculate the mean time each physician spent with patients as follows: PHYSICIAN TIMES WITH
PATIENTS AVERAGE (MEAN) TIME
WITH PATIENTS
Beasley 8, 6, 7 7
Robinson 5, 9, 9 7.7
Baumstark 1 0, 7 8.5
Wolf 1 2, 5, 1 1 9.3

A

A

C

A

C

D

D

B

### All Women's Hospital reports the following statistics: Single births Vaginal 40 c-section 0 Twin births Twins—vaginal 12 (6 sets) Twins—c-section 8 (4 sets) Other multiple births 0 Intermediate fetal deaths Vaginal 5 c-section 0 Late fetal deaths Vaginal 2 c-section 0 How many deliveries occurred? A. 50 B. 57 C. 60 D. 67

B 40 + 10 + 5 + 2 = 57

### The inpatient census at midnight is 67. Two patients were admitted in the morning; one died 2 hours later; the second patient was transferred to another facility that same afternoon. The inpatient service days for that day will be A. 65. B. 67. C. 68. D. 69.

D 67 + 2 = 69 admissions/discharges same day (Transfers to other facilities and deaths are forms of discharge)

### Bayside Hospital has 275 adult beds, 30 pediatric beds, and 40 bassinets. In a nonleap year, inpatient service days were 75,860 for adults, 7,100 for pediatrics, and 11,800 for newborns. What was the average daily census for the year? A. 227 B. 208 C. 207 D. 259

A (75,860 + 7,100) / 365 = 227
(Note: Average daily census includes adult and pediatrics, but NOT newborns.)

B

### Mr. McDonaldson was admitted to your hospital at 10:45 PM on January 1. He died at 4:22 AM on January 3. How many inpatient service days did Mr. McDonaldson receive? A. 1 B. 2 C. 3 D. 4

B The day of admission is counted as an inpatient service day, but the day of discharge is not.

### A patient admitted to the hospital on January 24 and discharged on February 9 has a length of stay of A. 16 days. B. 15 days. C. 17 days. D. 14 days.

A 1/24 - 31 = 8 days + 2/1 through 2/8 = 8 days so 8 + 8 = 16 (Count day of admission but not discharge)

### Royal Palm Hospital has 500 beds and 55 bassinets. In February of a nonleap year, it reported the following statistics: Inpatient service days Adult and pediatric 12,345 Newborn 553 Discharges: Adult and pediatric 1,351 Newborn 77 Discharge days Adult and pediatric 9,457 Newborn 231 29. What was the percentage of occupancy for adults and pediatrics in February? A. 84.8% B. 88.2% C. 79.6% D. 80.5%

B (12,345 × 100) / (500 × 28) = 88.2%

### Inpatient service days Adult and pediatric 12,345 Newborn 553 Discharges: Adult and pediatric 1,351 Newborn 77 Discharge days Adult and pediatric 9,457 Newborn 231 30. What was the average length of stay at Royal Palm Hospital in February? A. 6.8 days B. 7 days C. 9 days D. 9.1 days

B 9,457 discharge days/1,351 discharges = 7 days. (Count the day of admission but not discharge.)

### You are responsible for calculating and reporting average length of stay (ALOS) for your hospital each month. This month, there were 92 discharges, and the total discharge days equal 875. One of the patients discharged this month had a total of 428 discharge days, so the ALOS is distorted by this unusually long stay. In this situation, you should report an ALOS of A. 9.51 days— no further information is necessary. B. 9.61 days and make a note that the one patient with an unusually long LOS was subtracted prior to making the calculation. C. 4.86 days and make a note that one unusually long LOS was subtracted prior to making the calculation. D. 4.91 days and make a note that the data on one patient with an unusually long LOS was subtracted prior to making the calculation.

D Only two answers, A and D, are correctly calculated. Should you choose to include the unusually long LOS, you should make a note to avoid confusing readers, which makes the answer "A" a poor choice. Should you choose to eliminate the potentially confusing LOS, you must subtract both the patient from the total discharges and the discharge days from the total discharge days.

### A hospital reported the following statistics during a nonleap year. Calculate the percentage of occupancy for the entire year. Time Period Bed Count Inpatient Service Days January 1 - May 31 200 28,690 June 1 -October 15 250 27,400 October 1 6-December 31 275 19,250 A. 85.2% B. 88% C. 90.0% D. 91.2%

B (28,690 + 27,400 + 19,250) × 100 (151 × 200) + (137 × 250) + (77 × 275) = 88.0 = 88%

### Lake City Health Center has 200 beds and 20 bassinets. In a nonleap year, Styles Hospital admitted 16,437 adults and children; 16,570 adults and children were discharged. There were 1,764 live births and 1,798 newborns discharged. The bed turnover rate for the year was A. 82.2. B. 82.7. C. 82.9. D. 93.5.

C Use the direct method, bed turnover. 16,570 adult and peds discharges/200 adult and peds beds = 82.85 = 82.9%

### Sea Crest Hospital has 200 beds and 20 bassinets. There was a sudden spurt in the birth rate in the town in November. The hospital set up five additional bassinets for the entire month. Total bed count days for Sea Crest Hospital in a nonleap year would be: A. 73,000. B. 80,300. C. 80,450. D. 80,455.

A 200 beds × 365 days in a non leap year = 73,000 (note: bassinets are excluded)

### Use the statistics provided in the table to compute the fetal death rate at All Women's Hospital for March. All Women's Hospital March Statistics Live births 225 Intermediate and late fetal deaths 5 Early fetal deaths 4 Newborn discharges 235 A. 4.0% B. 1.78% C. 2.2% D. 1.77%

C (5 × 100) = 2.2% (225 + 5)

### The number of births in the facility in October is: A. 53. B. 55. C. 56. D. 58. DELIVERED TOTAL DELIVERED BY C-SECTION Live Single infant Twins 50 3 sets 15 1 set Dead Early fetal Late fetal 1 1 0 1

C 50 + (3 sets of twins × 2 births per set) = 56 births

### The number of deliveries in the facility in October is A. 53 B. 55 C. 56 D. 58

B Multiple births are one delivery; fetal deaths are counted as deliveries 50 + 3 + 1 + 1 = 55

D

D

### Tampa Bay Health Center discharged 6,069 adults/children and 545 newborns last year. A total of 1,648 adults/children and 1,279 newborns were seen in the emergency department. Information on the deaths at Happy Valley last year is listed below. Use the data to answer the next two questions. INPATIENT DEATHS Adult/child 245 < 48 hrs 105 > 48 hrs Newborn 8 < 48 hrs 3 > 48 hrs OUTPATIENT (ED) DEATHS Adult/child 2 Newborn 0 FETAL DEATHS Early 1 Intermediate 3 Late 2 What was the gross (hospital) death rate at Tampa Bay Health Center last year? A. 3.8% B. 5.4% C. 5.5% D. 5.6%

C Calculations: 361 total inpatient deaths × 100/6614 total discharges = 5.45 = 5.5% Fetal deaths and outpatient deaths are not included in this calculation.

### INPATIENT DEATHS Adult/child 245 < 48 hrs 105 > 48 hrs Newborn 8 < 48 hrs 3 > 48 hrs OUTPATIENT (ED) DEATHS Adult/child 2 Newborn 0 FETAL DEATHS Early 1 Intermediate 3 Late 2 41. What was the net death rate at Tampa Bay Health Center last year? A. 1.6% B. 1.7% C. 1.8% D. 1.9%

B Calculations: (108 total inpatient deaths > 48 hours) × 100 = 10800
(6,614 total discharges - 253 deaths < 48 hours) = 6,361 =1.697 = 1.7%

### During the month of September, Superior Health Care Center had 1,382 inpatient discharges, including 48 deaths. There were 38 deaths over 48 hours. Statistics also show 4 fetal deaths, 3 DOAs, and 4 inpatient coroner's cases. Which of the following calculations is correct to figure the net death rate? A. (48 × 100)/ (1,382 - 10) B. (48-10 × 100)/ (1,382 - 10) C. (1,382 × 100)/ (48 - 10) D. (1,382 - 10) × 100/ (48 - 10)

B 48 - 38 deaths over 48 hours = 10 deaths less than 48 hours. (48 - 10) (100) (1,382 - 10)

B

B

### Still thinking about Mr. Woodley and his long stay, if you were to graph the ALOS for the facility for 2010, which of the following graphs would you expect to see? A. B. C. D.

C LOS would increase through the year and drop when patient is discharged.

### The New Beginnings Maternity Center recorded the following statistics in December: FETAL DEATHS EARLY 240 INTERMEDIATE 40 LATE 32 BIRTHS 980 DELIVERIES 994 NEWBORN DISCHARGES 1,008 What was the fetal death rate at New Beginnings Maternity Center in December? A. 6.8% B. 7.3% C. 7.4% D. 31.8%

A (72 intermediate and late fetal deaths × 100) = 7,200 = 6.8% (980 births + 72 intermediate and late fetal deaths) 1052

### The statistics reported for a 300-bed hospital for 1 year were 20,932 discharges with 136,651 discharge days and 3,699 consultations performed. What was the consultation rate for the year? A. 16.5% B. 17.0% C. 17.7% D. 18.0%

C (3,699 × 100) / 20,932 = 17.7%

A

C

D

C

B

C

A

A

D

B

B

A

A

A

D

C

D

A

A

### The time period of a facility's Institutional Review Board (IRB) or Independent Ethics Committee (IEC) registration with the Department of Health and Human Services (HHS) is A. 6 months. B. 1 year. C. 2 years. D. 3 years.

D The Institutional Review Board (IRB) or Independent Ethics Committee (IEC) registration is effective for 3 years and must be renewed at the end of that period of time to remain effective. If the information on record with the Office for Human Research Protections (OHRP) for the IRB/IEC registration needs to be changed, those changes should be submitted within 90 days of the change. All updates of the IRB/IEC registration using the electronic system automatically renew the IRB/IEC registration for another 3 years. Complete updates (the Federal Wide Assurance [FWA] is fully completed) submitted in hard copy renew an FWA for another 3 years, while limited updates (the FWA is partially completed) submitted in hard copy will not change the FWA expiration date. For additional information you may want to visit
http://www.hhs.gov/ohrp/humansubjects/assurance/renwirb.htm

D

C

B

A

### You have been conducting productivity studies on your coders and find that 20% of their time is devoted to querying physicians about missing or unclear diagnoses. Assuming your coders work a 7-hour day, how many minutes do they spend per day querying physicians? A. 21 B. 56 C. 84 D. 140

C 7 hours per day × 60 minutes per hour = 420 minutes per day. 20% of 420 = 84

### Venice Bay Health Center collected the data displayed below concerning their four highest volume MS-DRGs. MS-DRG A MS-DRG B MS-DRG C MS-DRG D CMS WEIGHT NUMBER CMS PATIENTS WITH THIS MS-DRG WEIGHT NUMBER PATIENTS WITH THIS MS-DRG CMS WEIGHT NUMBER PATIENTS WITH THIS MS-DRG CMS WEIGHT NUMBER PATIENTS WITH THIS MS-DRG 2.023 323 0.987 489 1 .925 402 1 .243 386 73. The MS-DRG that generated the most revenue for Venice Bay Health Center is A. MS-DRG A. B. MS-DRG B. C. MS-DRG C. D. MS-DRG D.

C Calculations:
• MS-DRG A = 2.023 × 323 = 653.43
• MS-DRG B = 0.987 × 489 = 482.64
• MS-DRG C = 1.925 × 402 = 773.85
• MS-DRG D = 1.243 × 386 = 479.80

### CMS has increased the weight for MS-DRG A by 14%, increased the weight for MS-DRG B by 20%, and decreased the weight for MS-DRG D by 10%. Given these new weights, which MS-DRG generated the most revenue for Venice Bay Health Center? A. MS-DRG A B. MS-DRG B C. MS-DRG C D. MS-DRG D

C Calculations:
• MS-DRG A = 2.023 × 0.14 = 0.283; 0.283 + 2.023 = 2.306 × 323 = 744.84
• MS-DRG B = 0.987 × 0.20 = 0.197; 0.987 + 0.197 = 1.184 × 489 = 578.98
• MS-DRG C = 1.925 × 402 = 773.85
• MS-DRG D = 1.243 × 0.10 = 0.124; 1.243 - 0.124 = 1.119 × 386 = 431.93

### Sea Side Clinic (SSC) provides episode of care service for four insurance companies. Data on services provided and reimbursement received are provided below. COMPANY UNITS OF SERVICE A REIMBURSEMENT FOR SERVICE A UNITS OF SERVICE B REIMBURSEMENT FOR SERVICE B TOTAL REIMBURSEMENT Lifecare 259 31 ,1 96.55 81 2 1 63,577.40 1 94,773.95 Get Well 786 1 00,859.52 465 96,929.25 1 97,788.77 SureHealth 462 54,631 .50 509 1 07,093.60 1 61 ,725.1 0 Be Healthy 21 9 26,991 .75 41 7 89,425.65 1 1 6,41 7.40 75. It would be most profitable for Sea Side Clinic to increase episode of care service with A. Lifecare. B. Get Well. C. SureHealth. D. BeHealthy.

D Arrive at the answer by calculating the reimbursement per unit for each service and averaging those answers, as shown below:
INSURANCE
COMPANY

UNITS OF
SERVICE A

REIMBURSEMENT FOR
SERVICE A
REIMBURSEMENT PER
UNIT FOR
SERVICE A

UNITS OF
SERVICE B

REIMBURSEMENT FOR
SERVICE B
REIMBURSEMENT PER
UNIT FOR
SERVICE B

TOTAL
REIMBURSEMENT AVERAGE
REIMBURSEMENT PER
UNIT OF
SERVICE
Lifecare 259 31,196.55 120.45 812 163,577.40 201.45 194,773.95 160.95
Get Well 786 100,859.52 128.32 465 96,929.25 208.45 197,788.77 168.39
SureHealth 462 54,631.50 118.25 509 107,093.60 210.40 161,725.10 164.33
Be Healthy 219 26,991.75 123.25 417 89,425.65 214.45 116,417.40 168.85

### The most profitable insurance company for the units of services Sea Side Clinic performs is A. service A with Lifecare. B. service B with GetWell.. C. service A with SureHealth. D. service B with BeHealthy.

D Reference the table above.

### The physicians at Sunset Shore Clinic reported the following statistics last Tuesday. PHYSICIAN SERVICE A SERVICE B SERVICE C Truba 10 18 14 Wooley 14 22 9 Howe 18 5 6 Masters 12 20 7 The physician who performed the highest number of services overall last Tuesday was Doctor A. Truba. B. Wooley. C. Howe. D. Masters.

B Calculate by adding total services:
PHYSICIAN
SERVICE A
SERVICE B
SERVICE C TOTAL
SERVICES
Truba 1 0 22 1 0 42
Wooley 1 4 22 9 45
Howe 1 8 5 6 29
Masters 1 2 20 7 39

### It takes twice as long to perform Service C, so the doctors decided Service C should count as two services for the purpose of calculating workload. If Service C counts twice as much as Service A or Service B, then the physician who provides the most services was Doctor A. Truba. B. Wooley. C. Howe. D. Masters.

A Double Service C in the table above.

B

C

A

C

D

C

B

A

B

D

D

C

B

C

B

D

D

C

A

B

A

### A study found that liver cancer rates per 100,000 males among cigarette smokers and nonsmokers in a major U.S. city were 48.0 and 25.4, respectively. The relative risk of developing liver cancer for male smokers compared to nonsmokers is A. 1.89. B. 15.6. C. 22.6. D. 48.0.

A RR = risk exposed divided by risk not exposed = 48 divided by 25.4 = 1.89

### This means newborn discharges are separated from the discharges of adults and children. Next, remember not to be fooled by beds set up temporarily to meet unusual admission needs; all occupancy statistics should be calculated based on approved, permanent beds only. The common rates used for census and occupancy statistics are as follows:

Health Statistics Definitions and Formulas
There are a number of important things to think about when you tackle census and occupancy statistics. First, remember when it comes to occupancy, beds and bassinets are counted separately.

### Daily Inpatient Census Total number of patients treated during a 24-hour period Inpatient Service Day Services received by one inpatient in one 24-hour period Total Inpatient Sum of all inpatient service days for each of the days in the period

Census Statistics

### Average Daily Census

Total inpatient service days for a period (excluding newborns)
Total number of days in the period

### FORMULA: Average LOS

Total length of stay (discharge days)
Total number of discharges

### Inpatient Bed Count Day

Counts the presence of one inpatient bed (occupied or vacant)
that is set up and staffed for use in one 24-hour period

### Total Inpatient Bed Count Day

Sum of inpatient bed count days for each of the days in a period

### Percentage of Occupancy FORMULA:

Total number of inpatient service days for a period × 100
Total inpatient bed count days × number of days in the period

### Direct Formula:

Total number of discharges for a period
Average bed count for the same period

### Indirect Formula: NOTE: The indirect formula must be used in cases where the bed count changes during the period in question.

Percentage of occupancy × Days in the period × 100
Average length of stay

### Death (Mortality) Rates Anesthesia Death Rate

Total number of deaths caused by an anesthetic agent × 100

Example: