Count events, not claim lines
Before you trust a utilization number, ask what one row in the file actually is.
- Service
- Value-based care finance
- Status
- in production
- Built
- May to July 2026
507 → 277
apparent admissions became true admissions
Source: Commit history and notes, Jul 2026
12,334 → 1,350
ER claim lines became actual ER visits
Source: Commit history and notes, Jul 2026
The problem
A hospital stay arrives in the claims file as many lines: one per day, per service, per revenue code. Counting lines as events made ER visits look about nine times higher than they were and nearly doubled admissions. Every chart built on those counts was wrong in the same direction.
What was built
A utilization engine turns claims into events. Hospital claim lines are merged into admissions with a length of stay and a 30-day readmission flag. ER claim lines are merged into visits. Skilled nursing and outpatient care are separated, each on its own tab. A first ER page came in May 2026; the full engine followed in July.
What was hard
Each wrong rule had to be found one at a time. Drugs given in the office were being counted as hospital admissions. An ER claim could also count as outpatient care. None of this is visible in a total; it only shows up when you trace one patient's month line by line.
Result
Merging day-by-day claim lines into real stays turned 507 apparent admissions into 277 true admissions, and 12,334 ER claim lines into 1,350 actual visits. The 30-day readmission rate per quarter is now something the practice can track; it is not reported here.
Where the numbers come from
The commit history and build notes from July 2026.