A system has been developed to generate hospital budgets based on the types of patients served. Several hundred classes of patients are defined according to clinical attributes such as diagnoses and surgical procedures, and for each class a profile of resources consumed is determined. The class definitions are based both on homogeneity of patient care processes as well as resource consumption. These profiles are expressed as revenues generated by charging departments and as costs both direct and indirect for all services. A methodology has been developed to associate all indirect costs with their source for each service included in the profile. From a forecast of patient load by class, budgets can be computed from the cost profiles and revenues determined from the charging profiles. Further analysis thus can include the effect of changes in case mix as well as changes in patient care processes. The effect on revenues of different reimbursement mechanisms can also be projected as a function of the case mix. The system is currently being implemented for demonstration and evaluation of the Yale-New Haven Hospital.
Evaluation is an increasingly important, time-consuming part of the medical care system. Use of explicit criteria in making such judgments has been recommended to promote consistency and fairness. This paper extends the use of criteria to screening so as to reduce the time physicians spend in evaluation. Can criteria be explicit and complete enough so that a suitably trained nonphysician can use them with acceptable accuracy? If so, physicians could concentrate on cases selected by the non-physicians, rather than on cases arbitrarily or randomly selected.
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