Casemix classification systems

Fetter, Robert B.

doi:10.1071/ah990016

Cited by 22 publications

(16 citation statements)

References 3 publications

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“…Reviewing the literature on change processes regarding the implementation of DRGs , we identified the tendency to interpret DRGs as an administrative innovation. Research focuses on the system and functions of DRGs (Fetter 1999) and there are numerous studies regarding the outcomes of DRGs, especially reduction in length of stay, decrease in costs, improvement of the patient treatment process (Chulis 1991; Trinh and Begun 1998), increase of the home care industry (Balinsky and Starkman 1987), and the impact of DRGs on hospital management (Crawford and Fottler 1985). Notably, research has emerged focusing on strategic planning regarding pricing policy, optimal patient mix, and the extension of the ambulatory services (Kimberly and Zajac 1985).…”

Section: Literature Reviewmentioning

confidence: 99%

Differences in the Implementation of Diagnosis‐Related Groups across Clinical Departments: A German Hospital Case Study

Ridder

Doege

Martini

2007

Health Services Research

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Section: Literature Reviewmentioning

confidence: 99%

Differences in the Implementation of Diagnosis‐Related Groups across Clinical Departments: A German Hospital Case Study

Ridder

Doege

Martini

2007

Health Services Research

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“…In response to increasing costs associated with the rapid evolution of healthcare technology, cost containment policies and case-mix classification systems have advanced worldwide over the past 20 years [7,8]. However, problems have emerged in situations where some patients are under-reimbursed if they have more CCs and have consumed more hospital resources than those with fewer CCs.…”

Section: Introductionmentioning

confidence: 99%

“…Research on the impact of CC on healthcare utilization and quality of medical care is needed, as this is important to hospital payment systems and medical outcome studies [7,8]. Many health-related problems increase with age, especially with respect to the number of chronic conditions [1].…”

Section: Introductionmentioning

confidence: 99%

The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data

Kuwabara

Imanaka

Matsuda

et al. 2008

Environ Health Prev Med

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Objectives With greater concern for efficient resource allocation and profiling of medical care, a case-mix classification was applied for the per-diem payment system in Japan. Many questions remain, one of which is the role of comorbidity and complication (CC) in grouping logic. We examined the association of the number of CC with the length of hospital stay (LOS) and hospital mortality as well as the proportion of LOS high outliers in 19 major diagnostic categories (MDCs).Methods This study was a secondary data analysis embedded in a government research project, including anonymous claims and clinical data during a 4-month period from July 2002. Every 19 MDC, LOS, hospital mortality or proportion of LOS high outliers was compared by the number of CC and presence of any procedures.Results From 82 special function hospitals, 241,268 patients were enrolled in this study. Among all patients, 50.5% were identified without any CCs, 32.4% with one or two, 13.4% with three or four, and 3.7% with over five CCs. The overall mean LOS was 22.15 days and hospital mortality 26.05 cases per 1,000 admissions. In any MDC, LOS and the proportion of outliers increased as the number of CC rose. The mortality rate increased prominently in the respiratory system and the hematology system. Conclusions This study demonstrated that the occurrence of more CC caused longer LOS and higher mortality in some major disease categories. Further study will clarify the association of the weighted CC with resource use through controlling procedures specific for MDC.

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“…Prospective payment is a way to measure hospital production and reimburse based on allocation of inpatient resources by case mix (Fetter, 1999). The DRG is used to focus on the "final product" of the hospital as a function of the bundle of goods and services that are consumed during hospitalization (Fetter, 1991).…”

Section: Historical Perspectivementioning

confidence: 99%

Adjustment of Inpatient Care Reimbursement for Nursing Intensity

Welton

Zone-Smith²,

Fischer³

2006

Policy, Politics, & Nursing Practice

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The Centers for Medicare and Medicaid Services has begun an ambitious recalibration of the inpatient prospective payment system, the first since its introduction in 1983. Unfortunately, inpatient nursing care has been overlooked in the new payment system and continues to be treated as a fixed cost and billed at a set per-diem "room and board" fee despite the known variability of nursing intensity across different care settings and diagnoses. This article outlines the historical influences regarding costing, billing, and reimbursement of inpatient nursing care and provides contemporary evidence about the variability of nursing intensity and costs at acute care hospitals in the United States. A remedy is proposed to overcome the existing limitations of the Inpatient Prospective Payment System by creating a new nursing cost center and nursing intensity adjustment by DRG for each routine-and intensive-care day of stay to allow independent costing, billing, and reimbursement of inpatient nursing care.

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Casemix classification systems

Cited by 22 publications

References 3 publications

Differences in the Implementation of Diagnosis‐Related Groups across Clinical Departments: A German Hospital Case Study

Differences in the Implementation of Diagnosis‐Related Groups across Clinical Departments: A German Hospital Case Study

The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data

Adjustment of Inpatient Care Reimbursement for Nursing Intensity

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