Y014151 1
0330326 86018282 AHA
DRG compliance measurement in the future.
Turner JM
Softw Healthc, Aug-Sep 1985, 3 (4) p48, ISSN 0753-1621 Jrnl Code: SIH
Lang.: ENG.
Jrnl Ann.: 8601
Subfile: Health
Desc.: *Computers; *Diagnostic Related Groups; *Hospitals; *Information Systems; *Management Information Systems; *Microcomputers

Y014151 2
0327492 8528?030 AHA
Preparing for the future today--product line management [interview by Sandy Downs]
Terenzio J
Healthc Comput Commun, Sep 1985, 2 (9) p56-8, ISSN 8750-149X Jrnl Code: GBG
Lang.: ENG.
Jrnl Ann.: 8512
Subfile: Health
Desc.: *Case Mix; *Commerce; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS; *Information Systems; *Management Information Systems; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 3
0327384 85281652 AHA
Medicare program: changes to the inpatient hospital prospective payment system and fiscal year 1986 rates--HCFA. Final rule.
Fed Regist, Sep 3 1985, 5 (170) p35646-759, ISSN 0097-6326 Jrnl Code B58
Lang.: ENG.
Jrnl Ann.: 8512
Subfile: Health
We are modifying the Medicare inpatient hospital prospective payment system in order to implement necessary changes arising from experience with the system. In addition, this final rule sets forth our first adjustment of the diagnosis-related group weights and classifications as required under section 1886 (d) (4) (C) of the Act. Also, in the addendum to this final rule, we are describing changes in the methods, amounts, and factors necessary to determine prospective payment rates for Medicare inpatient hospital services. Changes to the Federal portion of the payment are applicable to discharges occurring on or after October 1, 1985. Changes to the hospital-specific portion are effective with hospital cost reporting periods beginning on or after October 1, 1985. In effect, these changes apply to the final year of the three-year transition period for the hospital prospective payment system. The addendum also sets forth the rate-of-increase limits (target amounts) for hospitals excluded fromthe prospective payment system.
Desc.: *Health Insurance for Aged and Disabled, Title 18--Legislation and Jurisprudence (LJ); *HEALTH INSURANCE FOR AGED--Legislation and Jurisprudence (LJ); *Hospitals; *Rate Setting and Review--Legislation and Jurisprudence (LJ); *RATE SETTING--Legislation and Jurisprudence (LJ); *Reimbursement Mechanisms--Legislation and Jurisprudence (LJ); *Reimbursement, Prospective--Legislation and Jurisprudence (LJ); United States

Y014151 4
0327334 85306604 MED
Critical appraisal of the DRG system: problem areas for DRG reimbursement in the USA.
Harper DL
Aust Clin Rev, Mar 1985, (16) p5-11,
ISSN 0726-?139
Jrnl Code: 9DYde:
Lang.: ENG.
Jrnl Ann.: 8512
Subfile: INDEX MEDICUS
One may conclude that the prospective payment system known as Diagnosis Related Groups is the initial thrust of the government to reduce the rate of expenditures for Medicare patients in the acute hospital setting. More will come and probably soon. Among the criticism and concern, one must not ignore the non-inclusion of the physician provider in this system. Cost shifting to the private payer will probably result in DRGs in that area also. Concern about the ability to provide the technology necessary to render quality care is utmost on the minds of providers. The shift of patients into the alternate health care field will leave hospitals with fewer patients who are overall much sicker and the hospital will have fewer dollars from which to provide that care. There is specific criticism of some of the DRG groupings and concern with the way in which physicians will be brought under the system. The issue of bad debts and care for the indigent must be addressed. A great deal of attention must be paid in the manner in which capital costs are reimbursed. Medical education costs must be satisfactorily addressed on a national basis. MEDPAR data used to provide data base for determining the DRG rates, must be upgraded to bring fairness to the system. Now medical technology must be examined quickly and the costs of those desirable technological advances incorporated into the DRG rate so as not to impede their use. Perhaps the greatest concern relates to the factors which will be incorporated into the rate basis and those which affect the allowable rate increases. (ABSTRACT TRUNCATED AT 250 WORDS)
Tags: Human
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Evaluation Studies; Expenditures, Health; *Financial Management; *Financial Management, Hospital; Management Information Systems; Professional Standards Review Organizations; PSRO; Rate Setting and Review; RATE SETTING ; *Reimbursement Mechanisms--Standards (ST); *Reimbursement, Prospective--Standards (ST); United States

Y014151 5
0327177 85304563 MED
Severity of illness within DRGs: impact on prospective payment.
Horn SD; Sharkey PD; Chambers AF; Horn RA
Am J Public Health, Oct 1985, 75 (10) p1195-9,
ISSN 0090-0036
Jrnl Code: 3XW
Lang.: ENG.
Jrnl Ann.: 8512
Subfile: AIM; INDEX MEDICUS
This study compares the financial impact of a Diagnosis Related Group (DRG) prospective payment system with that of a Severity of Illness-adjusted DRG prospective payment system. The data base of about ?06,000 discharges is from 15 hospitals, all of which had a Health Care Financing Administration (HCFA) DRG case mix index greater than 1. In order to pool the data over the 15 hospitals, all charges were converted to costs, normalized to Fiscal Year 1983, and adjusted for medical education and wage levels. The findings showed that, for the study population as a whole, DRGs explained 28 per cent of the variability in resource use per case while Severity of Illness-adjusted DRGs explained 61 per cent of the variability in resource use per case. When we simulated prospective payment systems based on DRGs and on Severity-adjusted DRGs, we found that the financial impact of the two systems differed by very little in some hospitals and by as much as 35 per cent of total operating costs in other hospitals. Thus, even with a data set that is relatively homogeneous (with respect to the HCFA DRG case mix index definition of hospitals), we found substantial inequities in payment when DRGs were not adjusted for Severity of Illness. These findings suggest that, with a more representative set of hospitals, the difference between unadjusted and Severity-adjusted DRG-based prospective payment could be greater than 35 per cent of a hospital's total operating costs.
Tags: Human; Support, U.S. Gov't, Non-P.H.S.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitalization--Economics (EC); Regression Analysis

Y014151 6
0326185 85293482 MED
The financial effects of emergency department-generated admissions under prospective payment systems.
Munoz E; Laughlin A; Regan DM; Teicher I; Margolis IB; Wise L
JAMA, Oct 4 1985, 254 (13) p1763-71,
ISSN 0098-7484
Jrnl Code: KFRde:
Lang.: ENG.
Jrnl Ann.: 8512
Subfile: AIM; INDEX MEDICUS
The purpose of this study was to assess the financial impact (revenues vs expenses) as measured by hospital charges and costs vs diagnosis-related group (DRG) revenues of prospective payment systems on emergency department-generated admissions for a large teaching hospital under two payment systems: Medicare and an all-payor system. All emergency department admissions were analyzed for the years 1983 (N = 4, 273) and 1984 (N = 4, 125) under both systems, using standard DRG methodology. Our findings were as follows: (1) With charges as a measure of expense under both payment schemes, all clinical departments had large groups of unprofitable patients: Medicare, $12, 895, 038; all-payor system, $15, 553, 893. (2) then costs were computed as the e (p\9se measure (using our hospital's cost-to-charge ratio), Medicare patients produced a deficit ($2, 363, 163); however, under an all-payor system there was a small net profit $4, 267, 859). (3) The implementation of federalized DRG reimbursement rates increased our losses for this population from 1983 to 1984. (4) Reductions in outlier reimbursement (10%) and teaching costs (25%) caused our revenues to drop substantially, potentiating our losses. These findings suggest that hospitals with large emergency department admission populations, particularly Medicare patients, may be at a significant financial disadvantage under prospective payment systems.
Desc.: Case Mix; Costs and Cost Analysis; COSTS; *Emergency Service, Hospital--Economics (EC); Fees and Charges; FEES; *Financial Management; *Financial Management, Hospital; Health Insurance for Aged and Disabled, Title 18--Economics (EC); HEALTH INSURANCE FOR AGED--Economics (EC); Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; Hospitals, Teaching--Economics (EC); New York City; *Patient Admission--Economics (EC) ; *Reimbursement Mechanisms--Economics (EC); *Reimbursement, Prospective--Economics (EC); United States

Y014151 7
0325787 85289186 MED
DRGs: implications for biomedical communications.
Allen RM; Wilson CN
J Biocommun, May 1985, 12 (2) p4-7,
ISSN 0094-2499
Jrnl Code: HIGde:
Lang.: ENG.
Jrnl Ann.: 8512
Subfile: INDEX MEDICUS
Diagnostic Related Groups (DRGs) form the basis for a new means of reimbursing hospitals for services provided to Medicare patients. A brief outline of the DRG system and a partial description of constraints of the system are introduced. Ramifications of this new prospective payment system and implications for biomedical communicators are presented and discussed.
Tags: Human
Desc.: *Case Mix; Cost Cntrol--Trends (TD); *Costs and Cost Analysis; *COSTS; Economics, Hospital--Trends (TD); *Information Services--Economics (EC); Reimbursement, Prospective--Legislation and Jurisprudence (LJ); United States

Y014151 8
0324578 85259411 AHA
DRG rural/urban squeeze eased by efficient system.
Edwards J
Healthc Comput Commun, May 1985, 2 (5) p46-9,
ISSN 8750-149X
Jrnl Code: GBG
Lang.: ENG.
Jrnl Ann.: 8512
Subfile: Health
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; Hospital Bed Capacity, 100 to 299; HOSP BED CAPAC 100; *Hospitals; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Missouri; *Rural Health

Y014151 9
0324465 8256806 AHA
A model for strategic and systems planners.
Smith RJ
Comput Healthc, Aug 1985, 6 (8) p57-8, 61,
ISSN 0745-1075
Jrnl Code: D98
Lang.: ENG.
Jrnl Ann.: 8511
Subfile: Health
An important relationship between strategic planning and information systems has developed through the advent of PPS.
Desc.: *Hospital Administration; *Information Systems; *Management Information Systems; *Planning Technics; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 10
0324043 85276034 MED
Impact of competition and cost containment on the university hospital.
King SS
Am J Cardiol, Aug 23 1985, 56 (?) p27C-31C,
ISSN 0002-9149
Jrnl Code: 3DQ
Lang.: ENG.
Jrnl Ann.: 8511
Subfile: AIM; INDEX MEDICUS
Health care delivery in the United States is proceeding through rapid evolution driven by changes in how health care providers are reimbursed. The current dominant philosophy in government is to alter the health care field from a heavily regulated one to one characterized by competition. By reducing regulatory constraints and encouraging competition, government believes more efficient health care delivery will result. Health care payment systems now include the diagnosis related group method, all-payor rates and contracting for services with major insurance companies on discount per diem, capitation and per case rates. Reduced use of resources assumes changes in the practice of medicine from an elaborate system of medical care to a more basic one. The implications are many and the possible effects severe. There will be reduced levels of support for medical education, particularly for fellows and for those beyond the third year of residency training. A decreased hospital census and the thrust to perform more services on an outpatient basis question the basic structure of medical education focused on the inpatient. Teaching hospitals will have to develop networking arrangements, a forced cooperativeness that threatens the autonomy of training and research programs. The recent entry of for-profit health care corporations into research may compromise the integrity of the university hospital as a center for clinical care, education and research.
Desc.: Case Mix; Cost Control; Delivery of Health Care--Economics (EC); Delivery of Health Care--Trends (TD); *Economic Competition; *Economics; Forecasting; Hospital Administration--Economics (EC); Hospital Administration--Trends (TD); *Hospitals, Teaching--Economics (EC); *Hospitals, Univ.--Economics (EC); Reimbursement Mechanisms

Y014151 11
0324042 85276033 MED
Impact of diagnosis related groups on medical practice.
May JJ
Am J Cardiol, Aug 23 1985, 56 (5) p16C-26C,
ISSN 0002-9149
Jrnl Code: 3DQ
Lang.: ENG.
Jrnl Ann.: 8511
Subfile: AIM; INDEX MEDICUS
This report discusses the incentives that a payment system based on diagnosis related groups (DRGs) imposes on hospitals and physicians and presents the author's view of current trends with respect to the extension of DRG-based payment to areas of medical and institutional care beyond the acute general hospital. It examines the impact of prospective payment based on DRGs in New Jersey, a state with more than 4 years of experience with this payment approach. In New Jersey, the system includes all payors, not just Medicare, and as a result, responses to the system in the form of organizational change, modifications in the practice of medicine and hospital/physician interactions have been unusually visible and marked. The report also examines some of the changes that have occurred and are occurring in the way medical records are kept, the internal strictures placed on physicians by hospitals and other factors which relate to the observed trends. Empirical data on changes in length of stay, number of admissions, and so forth, are presented and preliminary explanations of the changes are offered, relating them to both payment rates and to organizational strategies on the part of hospitals.
Desc.: Cardiology--Economics (EC); *Case Mix; *Costs and Cost Analysis; *COSTS; *Delivery of Health Care--Economics (EC); Hospital Administration--Economics (EC); Hospitalization--Economics (EC); Hospitals, General--Economics (EC); Length of Stay--Economics (EC); Medical Records; New Jersey; Patient Admission--Economics (EC)

Y014151 12
0323690 85271102 MED
Hospital cost control in Norway: a decade's experience with prospective payment.
Crane TS
Public Health Rep, Jul-Aug 1985, 100 (4) p406-17,
ISSN 0090-2818
Jrnl Code: QJA
Lang.: ENG.
Jrnl Ann.: 8511
Subfile: AIM; INDEX MEDICUS
Under Norway's prospective payment system, which was in existence from 1972 to 1980, hospital costs increased 15.8 percent annually, compared with 15.3 percent in the United States. In 1980 the Norwegian national government started paying for all institutional services according to a population based, morbidity-adjusted formula. Norway's prospective payment system provides important insights into problems of controlling hospital costs despite significant differences, including ownership of medical facilities and payment and spending as a percent of GNP. Yet striking similarities exist. Annual real growth in health expenditures from 1972 to 1980 in Norway was 2.2 percent, compared with 2.4 percent in the United States. In both countries, public demands for cost control were accompanied by demands for more services. And problems of geographic dispersion of new technology and distribution of resources were similar. Norway's experience in the 1970s demonstrates that prospective payment is no panacea. The annual budget process created disincentives to hospitals to control costs. But Norway's changes in 1980 to a population-based methodology suggest a useful approach to achieve a more equitable distribution of resources. This method of payment provides incentives to control variations in both admissions and cost per case. In contrast, the Medicare approach based on Diagnostic Related Groups (DRGs) is limited, and it does not affect variations in admissions and capital costs. Population-based methodologies can be used in adjusting DRG rates to control both problems. In addition, the DRG system only applies to Medicare payments; the Norwegian experience demonstrates that this system may result in significant shifting of costs onto other payors.
Tags: Comparative Study; Human
Desc.: Case Mix; Cost Control; *Economics, Hospital; Economics, Hospital--Trends (TD); Economics, Medical; Expenditures, Health--Trends (TD); Health Insurance for Aged and Disabled, Title 18; HEALTH INSURANCE FOR AGED; Health Maintenance Organizations--Economics (EC); HMO--Economics (EC); Hospital Bed Capacity; HOSP BED CAPAC; Norway; Nursing Homes; Public Policy; *Reimbursement Mechanisms--Economics (EC); *Reimbursement, Prospective--Economics (EC); Reimbursement, Prospective--Trends (TD); United States

Y014151 13
0322873 85263906 MED
Building a classification system that works.
Unger J
J Nurs Adm, Jul-Aug 1985, 15 (7-8) p1-24,
ISSN 0002-0443
Jrnl Code: JEL
Lang.: ENG.
Jrnl Ann.: 8511
Subfile: AIM; INDEX MEDICUS
The process one nursing department used to develop, test, implement, and monitor a definitive patient classification system that accurately predicts needed nursing staff and correlates with department budget is described. The author demonstrates that staff nurses with ordinary skills and experience, using limited resources of time and money, can build a valid, reliable, workable system amenable to computerization and future use in costing out nursing care on an individual patient or diagnosis related group (DRG) basis.
Tags: Human
Desc.: Budgets; Case Mix; Nursing Care; Nursing Records; Nursing Service, Hospital--Economics (EC); *Nursing Service, Hospital--Organization and Administration (OG); *Nursing Staff, Hospital--Supply and Distribution (SD); *Patients--Classification (CL); Personnel Staffing and Scheduling; PERSONNEL STAFFING

Y014151 14
0322653 85260690 MD
Hospital DRGs and the need for long-term care services: an empirical analysis.
Meiners MR; Coffey RM
Health Serv Res, Aug 1985, 20 (3) p359-84,
ISSN 0017-9124
Jrnl Code: G2L
Lang.: ENG.
Jrnl Ann.: 8511
Subfile: INDEX MEDICUS
The Medicare DRG-based Prospective Payment System (PPS) encourages hospitals to reduce length of stay for elderly patients. Thus, discharges to long-term care services are expected to increase. Maryland hospital data for 1980 are used to identify those DRGs which most frequently represent patients discharged to nursing home and home health care services; explores the incentive to discharge earlier under PPS those patients needing long-term care versus short-term care; and describes characteristics of patients most likely to face increased pressure of earlier discharge to nursing homes and home health programs. Because only a limited set of patient characteristics are available from Maryland hospitals, data from a study of San Diego nursing homes are used to explore further the sociodemographic and health status measures associated with unusually long stays in a hospital prior to nursing home placement. This research suggests that the DRG reimbursement system gives hospitals a strong incentive for earlier discharge of patients needing long-term care services. However, hospitals that target only long-term care patients for early discharge will not substantially gain under PPS because these patients represent a mall portion of the cases treated in the hospital and a small percentage of unreimbursed days.
Tags: Human
Desc.: Aged; California; *Case Mix; *Costs and Cost Analysis; *COSTS; *Health Insurance for Aged and Disabled, Title 18; *HEALTH INSURANCE FOR AGED; *Health Services Needs and Demand; *HEALTH SERVICES NEED; *Health Services Research; Home Care Services--Utilization (UT); Length of Stay--Economics (EC); *Long Term Care--Utilization (UT); Maryland ; Nursing Homes--Utilization (UT); *Patient Discharge--Economics (EC); *Reimbursement; Mechanisms; *Reimbursement, Prospective; Self Care--Utilization (UT)

Y014151 15
0321947 85251946 ME
A modification of the International Classification of Diseases for Uniform Coding of Diagnosis, Procedures, and Medications. The Perinatal Intensive Care Computer System.
Myers TF; Ahmed GS; Anderson CL; Addelson R; Moyer J
Am J Perinatol, Jul 1985, 2 (3) p240-1,
ISSN 0735-1631
Jrnl Code: AA3
Lang.: ENG.
Jrnl Ann.: 8511
Subfile: INDEX MEDICUS
Tags: Human
Desc.: *Case Mix; Computers; *Costs and Cost Analysis; *COSTS; Forms and Records Control; FORMS CONTROL; Infant, Newborn; *Infant, Newborn, Diseases; Information Systems; *Medical Records

Y014151 16
0321932 85251406 AHA
Critical appraisal of the DRG system. Problem areas for DRG reimbursement in the U.S.A.
Harper DL
Aust Health Rev, 1985, 8 (1) p14-21,
ISSN 0156-5788
Jrnl Code: 9GCde:
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: Health
This Prospective Payment System (PPS) utilising Diagnosis Related Groups (DRGs) which was introduced for the reimbursement of acute care hospitals for Medicare patients in the U.S., was adopted primarily to control the rapidly rising costs of health care and as an initial effort to retain the solvency of the Nation's Medicare Hospital Insurance Trust Fund. It is this factor, an overall decrease of health care dollars to health care providers and not the DRG system, which has generated the most criticism and concern. The DRG system, as a method to accomplish control of the expenditure of health care dollars and the method of implementation of this system in the United States, also generates criticism and concern from health care providers. One thing is certain, health care providers in the United States have seen just the beginning of what promises to be a rapidly changing environment driven by the need to control costs. The challenge will be to provide quality health care in a price competitive environment. This paper attempts to explore some of the criticisms and concerns of health care providers that result from the threat to reduce health care dollars and the methodology implemented to accomplish that objective.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Economics, Hospital--Trends (TD); Quality of Health Care--Economics (EC); *Reimbursement Mechanisms; *Reimbursement, Prospective United States

Y014151 17
0321721 85240277 AHA
Hospitals upgrading computers in response to Medicare PPS.
McDermott RE; Lloyd BR
Mod Healthc, Jul 5 1985, 15 (14) p182-4,
ISSN 0160-7480
Jrnl Code: NFA
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: Health
Desc.: *Computers; *Financial Management--Trends (TD); *Financial Management, Hospital--Trends (TD); *Health Insurance for Aged and Disabled, Title 18; *HEALTH INSURANCE FOR AGED; *Information Systems--Standards (ST) *Management Information Systems--Standards (ST); *Reimbursement Mechanisms *Reimbursement, Prospective; United States

Y014151 18
0321669 85234617 AHA
Quality control: a key to cost control.
Brewster AC; Bradbury RC
Health Manage Q, Spring 1985, p9-12,
Jrnl Code: HMS
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: Health
Desc.: Analysis of Variance; *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitals; Management Information Systems; New England; *Quality Assurance, Health Care--Methods (MT)

Y014151 19
0321637 85234004 AHA
The new healthcare management information: consolidated operational reporting.
Kelliher ME
Hosp Health Serv Adm, Jul-Aug 1985, 30 (4) p36-46,
ISSN 0364-4553
Jrnl Code: G9T
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: Health
Most healthcare executives realize that hospitals financed through prospective payment cannot be effectively managed with conventional systems. They recognize the need for improved operational accountability, control and planning, though few have determined the means for achieving it. This article discusses a prototype operational control system designed to get beyond fragmented productivity and cost accounting efforts to an integrated, consolidated operational reporting system which will assist management in achieving its fiscal objectives. Consolidated Operational Reporting (CORE) at the Univ. of California San Diego (UCSD) Medical Center consists of integrated product costing, labor productivity, inventory control, and productivity of capital. CORE enables top management through cost and performance indicators to proactively manage operations. Mid-level managers are a critical link to the CORE system. These front-line managers must understand the relationship between their regular operational decisions and the cost of hospital services. To promote this, UCSD conducts extensive mid-management seminars in operational control. Now these managers can reasonably be expected to understand, negotiate and act on accomplishing performance targets while being regularly updated, through CORE, as to their success at attaining the objective and the cost of the accomplishment.
Tags: Human
Desc.: Accounting; California; Efficiency; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); Hospital Bed Capacity, 300 to 499; HOSP BED CAPAC 300; *Information Systems ; Inventories, Hospital--Economics (EC); Management Audit; *Management Information Systems

Y014151 20
0321625 85233966 AH
Opportunities in management information.
Moskalski JM
Issues Health Care, 1985, 6 (1) p33-5,
Jrnl Code: G3N
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: Health
Desc.: Case Mix; Concurrent Review; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); *Information Systems; *Management Information Systems; Reimbursement Mechanisms; United States

Y014151 21
0321513 85232710 AHA
DRG clinical surveillance: an approach to internal control.
D'Orazio LP; Goldschmidt NB
Healthc Financ Manage, Jul 1985, 39 (7) p76-7, 80-4,
ISSN 0735-0732
Jrnl Code: GBC
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: Health
In the present healthcare environment, internal control of hospital resources is becoming increasingly important. One hospital's approach to instituting internal control is the development of a DRG clinical surveillance program. This program uses utilization review in conjunction with quality assurance to provide the hospital with a working framework for determining whether hospital admission is appropriate or whether an alternative method of healthcare delivery should be used.
Desc.: *Case Mix; *Concurrent Review--Organization and Administration (OG); *Costs and Cost Analysis; *COSTS; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); Hospital Bed Capacity, 100 to 299; HOSP BED CAPAC 100; *Information Systems ; *Management Information Systems; Pennsylvania; *Quality Assurance, Health Care--Organization and Administration (OG); *Utilization Review--Organization and Administration (OG)

Y014151 22
0321442 85229868 AHA
Detailed patient information: a key to case-mix management.
Schaffer B
Comput Healthc, Jul 1985, 6 (7) p27-8,
ISSN 0745-1075
Jrnl Code: D98
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: Health
Desc.: California; *Case Mix; *Costs and Cost Analysis; *COSTS; Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Medical Records

Y014151 23
0321312 85250641 MED
Surgonomics: the identifier concept. Hospital charges in general surgery and surgical specialties under prospective payment systems.
Munoz E; Regan DM; Margolis IB; Wise L
Ann Surg, Jul 1985, 202 (1) p119-25,
ISSN 0003-4932
Jrnl Code: 67Sde:
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: AIM; INDEX MEDICUS
Surgical care is entering a new payment era for inhospital care using the diagnostic related group (DRG) mechanism for Medicare. A study at The Long Island Jewish-Hillside Medical Center showed that a majority of its surgical DRGs would be unprofitable under the proposed reimbursement scheme. This study was undertaken to develop a method of allowing the hospital to group patients with each DRG that would show a difference in hospital charges and be clinically meaningful to surgeons. The study implementors tested the hypothesis that entities called identifiers, arbitrarily chosen as mode of admission [emergency (+ER vs. nonemergency (-ER)] and presence (+T) or absence (-T) of blood transfusion, would show a difference in charges (mean hospital charge exclusive of physician fees) within a DRG. Nine hundred five patients in nine DRGs encompassing general surgery, thoracic surgery, cardiac surgery, neurosurgery, orthopedics, urology, and head and neck surgery were studied. For ER identifier, eight of nine DRGs were found to be positive (greater than 20% difference in charges between positive and negative identifier); for T identifier, all DRGs (9) were positive. These findings demonstrate that these identifiers may enable teaching institutions to disaggregate each DRG and, in this way propose more equitable reimbursement rates.
Tags: Human
Desc.: Blood Transfusion--Economics (EC); Case Mix; *Costs and Cost Analysis; *COSTS; Emergencies; Fees and Charges; FEES; *Health Insurance for Aged and Disabled, Title 18--Economics (EC); *HEALTH INSURANCE FOR AGED--Economics (EC); Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Hospital Dept.s--Economics (EC); *HOSP DEP--Economics (EC); New York City; Probability; *Reimbursement Mechanisms--Economics (EC); *Reimbursement, Prospective--Economics (EC); *Surgery Dept., Hospital--Economics (EC); *SURG DEP--Economics (EC)

Y014151 24
0321126 85248563 MED
Nosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control. Economic implications for hospitals under the prospective payment system.
Wenzel RP
Am J Med, Jun 28 1985, 78 (6B) p3-7,
ISSN 0002-9343
Jrnl Code: 3JUde:
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: AIM; INDEX MEDICUS
It is obvious that escalating costs of medical care must be curbed. Fortunately, since the major proportion of health care costs relate to inpatient management, the diagnosis-related group "experiment" forces the medical community to examine carefully the costs of the specific components of health care delivery. One such item is the cost of nosocomial infections. With respect to the potential importance of hospital-acquired infections and reimbursement under the diagnosis-related group system, several points should be underscored. Nosocomial infections represent a direct economic liability of $5 to $10 billion annually in the United States. Under the new diagnosis-related group reimbursement system, it is probable that very little of the costs related to excess stay resulting from infections will be reimbursed to hospitals. For the first time, there are data indicating that as much as one third of hospital-acquired infections can be prevented by implementing effective infection control programs. The currently available information suggests that under the existing diagnosis-related group reimbursement system, hospitals with effective infection control programs can significantly improve their economic position.
Tags: Human
Desc.: Adult; Age Factors; Aged; *Case Mix; *Costs and Cost Analysis; *COSTS; *Cross Infection--Economics (EC); Cross Infection--Prevention and Control (PC); Length of Stay; Middle Age; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 25
0320156 85239184 MED
Management information systems. New challenges to meet changing needs.
Steinwachs DM
Med Care, May 1985, 23 (5) p607-22,
ISSN 0025-7079
Jrnl Code: LSMde:
Lang.: ENG.
Doc Type: Review
Jrnl Ann.: 8510
Subfile: INDEX MEDICUS (38 Refs.)
Desc.: Ambulatory Care--Organization and Administration (OG); Case Mix; Cost Control; Efficiency; Health Resources--Trends (TD); *Health Services Research--Methods (MT); *Health Services--Organization and Administration (OG); Hospital Administration--Trends (TD); *Information Systems; Insurance, Health--Organization and Administration (OG); *Management Information Systems; United States

Y014151 26 319608 85233336 MED
Is compression occurring in DRG prices
Lave JR
Inquiry, Summer 1985, 22 (2) p142-6,
ISSN 0020-1731
Jrnl Code: GOTde:
Lang.: ENG.
Jrnl Ann.: 8510
Subfile: INDEX MEDICUS
Many analysts believe that the prices of truly high cost DRGs are set low relative to their actual costs whereas the prices of truly low cost DRGs are set high relative to their costs. To test whether such "compression" is occurring, I examined the algorithm that the Health Care Financing Administration used to create its DRG pricing structure. I then compared the HCFA algorithm with the more refined weighting systems used by Maryland and New Jersey to create their DRG payment systems. I found that compression is indeed occurring in the Medicare system relative to both the New Jersey and the Maryland systems. This compression will assume special urgency for some hospitals when the standardized national DRG payment system is phased in or if stringent limits are placed on the overall rate of increase in DRGs.
Tags: Human; Support, Non-U.S. Gov't
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Health Insurance for Aged and Disabled, Title 18--Economics (EC); *HEALTH INSURANCE FOR AGED--Economics (EC); Maryland; New Jersey; *Rate Setting and Review; *RATE SETTING; *Reimbursement Mechanisms--Economics (EC); *Reimbursement, Prospective--Economics (EC); Statistics; United States Health Care Financing Administration

Y014151 27
03?8641 85205883 AHA
Implementing a DRG-driven acuity system for nurse staffing under prospective hospital payment.
Caterinicchio RP
Hosp Top, May-Jun 1985, 63 (3) p6-7, 13,
ISSN 0018-5868
Jrnl Code: GD6
Lang.: ENG.
Jrnl Ann.: 8509
Subfile: Health
The "DRG-Nursing Unit Manager" is a multifunctional microcomputer software product designed for the effective management of nursing under a DRG prospective payment environment. The system's signature is its simplicity and versatility, and will prove to be a significant management tool for the nursing department. Written to execute on the IBM-PC-XT microcomputer, the nurses can start an application, enter patient demographics, assign Major Diagnostic Category (MDC) and Diagnosis Related Group (DRG) numbers, or make report selections. With a minimal amount of keyboard usage the system collects and saves key data fields, retrieves nursing measures and length of stay norms, and produces reports on a demand basis. The primary report produced by the system is a patient census listing with expected nursing intensities per patient for the next shift which is converted to a staffing projection for the upcoming three shifts for the exiting census. The system also allows the costing out of nursing services and produces charge-equivalent statistics so that the nursing station can function as a revenue-producing center. Such an approach permits the identification of DRGs which are "winners" or "losers" under routine care costs.
Desc.: *Case Mix; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG) ; *Nursing Service, Hospital--Organization and Administration (OG); Personnel Staffing and Scheduling--Methods (MT); PERSONNEL STAFFING--Methods (MT) United States

Y014151 28
0318622 85205760 AHA
Financial solvency under DRGs.
Johnson RL
Healthc Comput Commun, Jun 1985, 2 (6) p48-9,
ISSN 8750-149X
Jrnl Code: GBG
Lang.: ENG.
Jrnl Ann.: 8509
Subfile: Health
Desc.: *Case Mix; Cost Benefit Analysis; *Costs and Cost Analysis; *COSTS; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); Hospital Bed Capacity, 100 to 299; HOSP BED CAPAC 100; *Information Systems--Economics (EC); *Management Information Systems--Economics (EC); United States

Y014151 29
0318438 85201000 AHA
Medicare program; changes to the inpatient hospital prospective payment system and fiscal year 1986 rates--HCFA. Proposed rule.
Fed Regist, Jun 10 1985, 50 (111) p24366-97,
ISSN 0097-6326
Jrnl Code: B58
Lang.: ENG.
Jrnl Ann.: 8509
Subfile: Health
We are proposing to modify the Medicare inpatient hospital prospective payment system in order to implement necessary changes arising from experience with the system and from certain recommendations of the Prospective Payment Assessment Commission provided under section 1886 (d) (4) (D) of the Social Security Act (the Act). In addition, this proposal sets forth our first adjustment of the diagnosis-related group weights and classifications as required under section 1886 (d) (4) (C) of the Act. In addition, in the addendum to this proposed rule, we are proposing changes in the methods, amounts, and factors necessary to determine prospective payment rates for Medicare inpatient hospital services. Changes proposed to the Federal portion of the payment would be applicable to discharges occurring on or after October 1, 1985. Proposed changes to the hospital specific portion would be effective with hospital cost reporting periods beginning on or after October 1, 1985. In effect, these changes would apply to the final year of the three-year transition period for the hospital prospective payment system. The addendum also sets forth our proposal for determining the rate-of-increase limits (target amounts) for hospitals excluded from the prospective payment system.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Health Insurance for Aged and Disabled, Title 18--Legislation and Jurisprudence (LJ); *HEALTH INSURANCE FOR AGED--Legislation and Jurisprudenc (LJ); *Hospitals; *Rate Setting and Review--Legislation and Jurisprudence (LJ); *RATE SETTING--Legislation and Jurisprudence (LJ); *Reimbursement Mechanisms--Legislation and Jurisprudence (LJ); *Reimbursement, Prospective--Legislation and Jurisprudence (LJ); United States Health Care Financing Administration; United States

Y014151 30
0316595 85205831 MED
DRGs spark interest abroad for planning.
Hospitals, Jun 1 1985, 59 (11) p3-4,
ISSN 0018-5973
Jrnl Code: GDL
Lang.: ENG.
Jrnl Ann.: 8509
Subfile: AIM; INDEX MEDICUS
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Europe; Hospitals; *Information Systems; *Management Information Systems

Y014151 31
0315960 85187503 AHA
The prospective payment system: information for the medical librarian and a selected annotated bibliography.
Grotzinger KM
Med Ref Serv Q, Spring 1985, 4 (1) p39-79,
ISSN 0276-3869
Jrnl Code: MRS
Lang.: ENG.
Jrnl Ann.: 8508
Subfile: Health
The implementation of the prospective payment system for inpatient Medicare services and the usage of Diagnosis Related Groups as a vehicle for allocation of monies to providers has impacted significantly the health care industry as a whole. Librarians are instrumental in providing information to key health care personnel to meet the strategic challenge of prospective payment. This article reviews the evolution of prospective payment by DRG and provides selected sources of information as a beginning in developing a knowledge of the facets of prospective payment and the health care environment.
Desc.: *Bibliography; *Case Mix; *Costs and Cost Analysis; *COSTS; *Health Insurance for Aged and Disabled, Title 18; *HEALTH INSURANCE FOR AGED; Libraries, Medical; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 32
0315913 85184923 AHA
A preliminary assessment. Digital imaging storage and retrieval in the 1980s.
J Health Care Technol, Summer 1984, 1 (1) p13-38,
ISSN 0748-075X
Jrnl Code: JHC
Lang.: ENG.
Jrnl Ann.: 8508
Subfile: Health
The current status of digital imaging storage and retrieval is described, as applied to both digitally created images and those converted from conventional films. Technologies that are beginning to play a role in digital image management--particularly, different configurations of Picture Archiving and Communications Systems (PACS)--are examined in terms of their stage of development, equipment, and operating costs. This assessment finds that the future success and diffusion of these systems will depend upon the diagnostic adequacy of digital images, improvements in image digitizing processes, and the availability of optical disk or other low-cost mass storage. In addition, the paper concludes that Medicare's prospective payment system will greatly influence the spread of this technology because of both the cost-saving incentives the system will place on health care professionals and the still-undetermined method of capital cost reimbursement.
Desc.: Data Display; Hospitals; *Information Systems; *Radiography--Instrumentation (IS); *Technology Assessment, Biomedical

Y014151 33
0315697 85180902 AHA
Management engineering's contribution to the strategic planning process.
McNash M
Health Care Strateg Manage, Apr 1985, 3 (4) p4-7,
ISSN 0742-1478
Jrnl Code: GAE
Lang.: ENG.
Jrnl Ann.: 8508
Subfile: Health
The Prospective Payment System (PPS) has initiated widespread changes in the health care environment. Increasing competition and diminishing revenues have forced many hospitals into a battle for survival. Those which survive will often attribute their success to careful and decisive strategic planning. As part of the strategic planning process, the use of management engineering has come to the forefront as a valuable addition to the management team. This article, the fourth in HCSM's series on organizational components of strategic planning, presents the many ways management engineering can support the strategic planning process, including the development and implementation of the strategic plan.
Desc.: *Hospital Administration; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); *Operations Research; Planning Technic; United States

Y014151 34
0314790 85188085 MED
The indirect costs of graduate medical education.
Cameron JM
N Engl J Med, May 9 1985, 312 (19) p1233-8,
ISSN 0028-4793
Jrnl Code: NOW
Lang.: ENG.
Jrnl Ann.: 8508
Subfile: AIM; INDEX MEDICUS
This analysis, aimed at measuring the indirect costs associate with hospital teaching programs, found that university teaching hospitals were 33 per cent more costly than no teaching hospitals with respect to direct hospital costs (excluding overhead) after adjustment for differences in case mix using diagnosis-related groups (DRGs). This study found major teaching hospitals (not administered by a university) to be 18 per cent and minor teaching hospitals 9 per cent more costly than nonteaching hospitals. These cost differentials were due primarily to the greater intensity of services provided in teaching settings rather than to the cost per unit of service. Inclusion of the full costs of physician services reduced the cost differences among teaching categories. Although teaching hospitals, especially university teaching hospitals, are demonstrable more expensive than nonteaching hospitals for the same types of cases, researchers and policy makers must consider the physician-substitution effect. This is particularly important in the light of the current controversy over the integration of physician costs for inpatient services into Medicare's DRG-based prospective-payment system
Tags: Support, Non-U.S. Gov't
Desc.: California; Case Mix; Costs and Cost Analysis; COSTS; *Education, Medical, Graduate--Economics (EC); Fees, Medical; Hospitals, Teaching--Classification (CL); *Hospitals, Teaching--Economics (EC); Internship and Residency--Economics (EC); INTERNSHIP--Economics (EC); Medical Assistance, Title 19--Economics (EC); Quality of Health Care--Economics (EC)

Y014151 35
0314329 85182127 MED
Estimating "reasonable cost" of Medicaid patient care using a patient-mix index.
Tamura H; Lauer LW; Sanborn F
Health Serv Res, Apr 1985, 20 (1) p27-42,
ISSN 0017-9124
Jrnl Code: G2L
Lang.: ENG.
Jrnl Ann.: 8508
Subfile: INDEX MEDICUS
A multiple regression method of defining "reasonable cost" for Medicaid reimbursement of nursing home patient care was implemented in Washington State in July 1978. A patient-mix index, the Katz ADL (Activities of Daily Living), was included in the regression equation as one of the independent variables to allow systematically for individual patient characteristics and needs in the rate-setting method. From the six measures investigated, the Katz ADL index was selected as the best predictor of patient care per patient-day cost. The way a "reasonable cost interval" of patient care per patient-day was established for each of 277 providers is described. Evidence is presented that this statistical rate-setting method contained efficiency incentives. The potential usefulness of such methods in obtaining management information at low cost should be given more consideration in efforts to reduce administrative costs of governmental health care programs, thus allocating scarce resources to patients on an equitable basis.
Tags: Female; Human; Male
Desc.: *Activities of Daily Living; Aged; *Case Mix; *Chronic Disease--Economics (EC); *Costs and Cost Analysis; *COSTS; *Medical Assistance, Title 19--Economics (EC); Methods; *Nursing Homes--Economics (EC); Rate Setting and Review; RATE SETTING; Regression Analysis; Reimbursement Mechanisms; Washington

Y014151 36
0313777 85172498 AHA
Cost containment through information management.
Bauman RA
Appl Radiol, Jan-Feb 1985, 14 (1) p19, 21,
ISSN 0160-9963
Jrnl Code: 38P
Lang.: ENG.
Jrnl Ann.: 8507
Subfile: Health
Federal legislation requiring prospective payment based on diagnosis-related groups for Medicare patients is causing dramatic changes in medicine. In radiology departments, these changes have focused attention on the benefits accruing from the use of computer-based information systems.
Desc.: Cost Control; Health Insurance for Aged and Disabled, Title 18; HEALTH INSURANCE FOR AGED; *Hospital Dept.s--Economics (EC); *HOSP DEP--Economics (EC); *Information Systems; *Management Information Systems *Radiology Dept., Hospital--Economics (EC); *RADIOL DEP--Economics (EC); United States

Y014151 37
0313456 85156127 AHA
A research paradigm for severity for illness: issues for the diagnosis-related group system.
Gertman PM; Lowenstein S
Health Care Financ Rev, 1984, Suppl p79-90,
Jrnl Code: GHX
Lang.: ENG.
Jrnl Ann.: 8507
Subfile: Health
The new Medicare Prospective Payment System has been challenged with regard to its fairness in reimbursing hospitals adequately, given the true resource needs in caring for patients. Most of these criticisms are now labelled as issues about adjustments for severity of illness. Critics point to the large amount of unexplained variation in charges and length of stay within the existing DRG's as indirect support for their contentions about inadequate adjustments. A paradigm is presented which argues that the key questions on the types of severity of illness measures to be utilized in future refinements of DRG's revolve around the extent and type of data which can feasibly be included in any workable reimbursement approach. A paradigm is presented on how these questions about information define a series of research options in the severity of illness arena.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitals--Utilization (UT); Length of Stay; Prognosis; United States

Y014151 38
0313454 85156125 AHA
Unrecognized redistributions of revenue in diagnosis-related group-based prospective payment systems.
Kominski GF; Williams SV; Mays RB; Dickens GT
Health Care Financ Rev, 1984, Suppl p57-69,
Jrnl Code: GHX
Contract/Grant No.: HS-04916
Lang.: ENG.
Jrnl Ann.: 8507
Subfile: Health
The Medicare prospective payment system, which is based on the diagnosis-related group patient-classification system, identifies previously unrecognized redistributions of revenue among diagnosis-related groups and hospitals. The redistributions are caused by two artifacts. One artifact results from the use of labor market indexes to adjust costs for the different prices paid by hospitas in different labor markets. The other artifact results from the use of averages that are based on the number of hopitals, not the number of patients, to calculate payment rates from average costs. The effects of these artifacts in a sample data set have been measured, and it was concluded that they lead to discrepancies between costs and payments that may affect hospital incentives--the overall payment for each diagnosis-related group--and Medicare's total payment.
Tags: Support, U.S. Gov't, P.H.S.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management, Hospital; New Jersey; *Rate Setting and Review--Methods (MT); *RATE SETTING--Methods (MT); *Salaries and Fringe Benefits; *SALARIES; United States

Y014151 39
0313452 85156123 AHA
The Severity of Illness Index as a severity adjustment to diagnosis-related groups.
Horn SD; Horn RA; Sharkey PD
Health Care Financ Rev, 1984, Suppl p33-45,
Jrnl Code: GHX
Lang.: ENG.
Jrnl Ann.: 8507
Subfile: Health
This article discusses the Severity of Illness case-mix groups, and suggests a refinement to diagnosis-related groups (DRG's) designed to accommodate the important element of patient severity. An application of the suggested refinement is presented in a discussion of the efficient production of hospital services. The following areas are addressed. A brief summary of the goals and development of the Severity of Illness Index, and the methodology used to collect severity of illness data on hospital inpatients. Comparative analyses of the resulting case-mix groups within hospitals, and an application of severity-adjusted diagnosis-related groups case-mix definitions. The contribution of the variation in physician practice patterns to the variation in resource use per patient within a hospital. Cross-hospital comparisons. Some of the consequences of incorporating a patient severity refinement into the prospective payment system.
Tags: Comparative Study; Support, Non-U.S. Gov't
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Factor Analysis, Statistical; Maryland; Models, Theoretical; Prognosis

Y014151 40
0313301 85151147 AHA
Medicare program; utilization and quality control peer review organization (PRO) reconsiderations and appeals--HCFA. Final rule.
Fed Regist, Apr 17 1985, 50 (74) p15364-74,
ISSN 0097-6326
Jrnl Code: B58
Lang.: ENG.
Jrnl Ann.: 8507
Subfile: Health
These regulations implement that portion of the Peer Review Improvement Act of 1982 that provides for reconsiderations and appeals of Utilization and Quality Control Peer Review Organization (PRO) initial determinations. We are establishing procedures for a PRO to reconsider both its initial denial determinations regarding the medical necessity, reasonableness and appropriateness of health care services furnished or proposed to be furnished to a Medicare beneficiary in a health care institution and the application of the limitation of liability provision. We are also including in this final rule procedures for administrative appeals to the Dept. following a PRO reconsidered determination and judicial review following administrative appeals. In addition, these regulations establish procedures for review of a PRO change in the diagnostic and procedural coding information that results in assignment of a discharge to a different diagnosis related group (DRG). This pertains to th review of claims for services furnished in hospitals reimbursed by Medicare under the prospective payment system.
Desc.: *Health Insurance for Aged and Disabled, Title 18--Utilization (UT); *HEALTH INSURANCE FOR AGED--Utilization (UT); *Professional Standards Review Organizations--Legislation and Jurisprudence (LJ); *PSRO--Legislation and Jurisprudence (LJ); United States Health Care Financing Administration; United States

Y014151 41
0312838 85169093 MED
Information systems implications of DRGs and prospective payment.
Lemon RB
Top Health Care Financ, Spring 1985, 11 (3) p59-62,
ISSN 0095-3814
Jrnl Code: VVG
Lang.: ENG.
Jrnl Ann.: 8507
Subfile: INDEX MEDICUS
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospital Administration; *Information Systems--Organization and Administration (OG) *Management Information Systems--Organization and Administration (OG); Medical Records Dept., Hospital; MED REC DEP; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 42
0312836 85169091 MED
Cost accounting strategies under prospective payment system.
McSweeney JM; Hebert MB; Holroyd RB
Top Health Care Financ, Spring 1985, 11 (3) p28-46,
ISSN 0095-3814
Jrnl Code: VVG
Lang.: ENG.
Jrnl Ann.: 8507
Subfile: INDEX MEDICUS
Desc.: *Accounting--Methods (MT); *Case Mix; *Costs and Cost Analysis; *COSTS; Efficiency; Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Marketing of Health Services ; Nursing Service, Hospital--Economics (EC); Rate Setting and Review; RATE SETTING; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 43
0311794 85159892 MED
Microcomputers in nursing administration. A software overview.
Finkler SA
J Nurs Adm, Apr 1985, 15 (4) p18-23,
ISSN 00?2-0443
Jrnl Code: JELde:
Lang.: ENG.
Jrnl Ann.: 8507
Subfile: AIM; INDEX MEDICUS
The current environment of prospective payment systems and cost control requires nursing administrators to have fast access to useful, reliable information. Microcomputers can be used by individuals who are not computer experts to generate that information. This article discusses the various types of computer software used on microcomputers and gives examples of nursing administration applications for microcomputer software.
Tags: Human
Desc.: Administrative Personnel; *Computer Programs; *Computers; Data Display; *Microcomputers; *Nurse Administrators; *Nursing Service, Hospital--Organization and Administration (OG)

Y014151 44
0310781 85133580 AHA
Materials management information systems. Important cost savings in the era of DRGs.
Ehrlich J
J Hosp Supply Process Distrib Mar-Apr 1985, 3 (2) p48-50,
ISSN 0738-2928
Jrnl Code: JAC
Lang.: ENG.
Jrnl Ann.: 8506
Subfile: Health
Desc.: *Information Systems--Economics (EC); *Management Information Systems--Economics (EC); *Materials Management, Hospital--Organization and Administration (OG); *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 45
0310518 85128843 AHA
The severity of illness index: an interview with Susan D. Horn.
Horn SD
Health Care Strateg Manage, Mar 1985, 3 (3) p19-22,
ISSN 07?2-1478
Jrnl Code: GAE
Lang.: ENG.
Jrnl Ann.: 8506
Subfile: Health
HCSM's interview this month is with Susan D. Horn, PhD, Associate Director, Center for Hospital Finance and Management at Johns Hopkins Univ. in Baltimore, Maryland. Dr. Horn, heading a research team at Johns Hopkins, has developed a patient classification system based on patient severity and medical diagnosis. In early testing, this index has proven more accurate than DRGs in capturing the homogeneity of resource use in individual diagnostic categories. Severity data also has implications for health care strategic planning. In this interview, Dr. Horn discusses the index and its benefits and then contrasts it to the DRG system.
Tags: Human
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Information Systems; *Management Information Systems; Maryland; Methods; *Patients--Classification (CL); Prognosis

Y014151 46
0308269 85129057 MED
Automation in the medical records department.
Packer CL
Hospitals, Mar 1 1985, 59 (5) p100, 102, 104,
ISSN 0018-5973
Jrnl Code: GDL
Lang.: ENG.
Jrnl Ann.: 8506
Subfile: AIM; INDEX MEDICUS
Desc.: *Automatic Data Processing--Trends (TD); *Case Mix; *Costs and Cost Analysis; *COSTS; Data Collection; Evaluation Studies; *Hospital Dept.s; *HOSP DEP; Hospital Shared Services; *Information Systems; *Management Information Systems; *Medical Records Dept., Hospital; *MED REC DEP; Microcomputers; United States

Y014151 47
0307659 85116148 AHA
Selected bibliography and glossary on DRG's prospective pricing.
Hatfield D
Ther Recreation J, 4th Quarter 1984, 18 (4) p56-61,
Jrnl Code: VQNe:
Lang.: ENG.
Jrnl Ann.: 8505
Subfile: Health
In 1982, the Tax Equity and Fiscal Responsibility Act modified the Section 223 Medicare Hospital reimbursement limits to include a case mix adjustment based on DRG's. In 1983, Congress amended the Social Security Act to include a national DRG-based hospital prospective payment system for all Medicare patients. In the view of many physicians and administrators the current formulation of DRG's constitute a workable and clinically coherent set of classifications that relate a hospital's case mix to the resources used and costs incurred by the hospital. DRG's are delineated based on principal diagnosis, secondary diagnosis, surgical procedures, age and the discharge status of the patients treated. Through DRG's, hospitals are able to gain an understanding of the patients they treat, the costs incurred and within reason, can anticipate the services required for specific illness. The classification of DRG's is a constantly evolving process. As coding procedures change, as more comprehesive data is collected, and as medical technology and treatment practices change, DRG's will need to be re-examined and revised. The following bibliography and glossary of terms highlights several key words and phases which are relevant to the overall discussion of DRG's.
Desc.: *Bibliography; *Case Mix; *Costs and Cost Analysis; *COSTS; *Nomenclature; United States

Y014151 48
0307430 85104363 AHA
Short-term case mix management with linear programming.
Hughes WL; Soliman SY
Hosp Health Serv Adm, Jan-Feb 1985, 30 (1) p52-60,
ISSN 0364-4553
Jrnl Code: G9T
Lang.: ENG.
Jrnl Ann.: 8505
Subfile: Health
One short-term economic incentive created by a prospective payment system based on diagnosis-related groups (DRGs) is for hospital managers to optimally and efficiently use the hospital's current mix of services to maximize net contribution. DRGs provide a managerial definition of the hospital's product by determining the number of patients discharged within each of the 467 groupings. Thus, the DRG case mix can be thought of as the hospital's product mix. As in major industry, linear programming models may prove useful in determining the hospital's financially optimal case mix. This article provides a framework for applying the linear programming concept to case mix planning in the hospital setting. It also presents an illustration and interpretation of a linear programming model that provides information about the short-term optimal case mix.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Financial Management, Hospital--Methods (MT); *Hospital Administration; Models, Theoretical; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 49
0304904 85085420 AHA
A case-mix in-service education program.
Arons RR
Med Group Manage, Jan-Feb 1985, 32 (1) p44-7,
ISSN 0025-7257
Jrnl Code: MA7
Lang.: ENG.
Jrnl Ann.: 8504
Subfile: Health
The new case-mix in-service education program at the Presbyterian Hospital in the City of New York is a fine example of physicians and administration working together to achieve success under the new prospective pricing system. The hospital's office of Case-Mix Studies has developed an accurate computer-based information system with historical, clinical, and demographic data for patients discharged from the hospital over the past five years. Reports regarding the cases, diagnoses, finances, and characteristics are shared in meeting with the hospital administration and directors of sixteen clinical departments, their staff, attending physicians, and house officers in training. The informative case-mix reports provide revealing sociodemographic summaries and have proven to be an invaluable tool for planning, marketing, and program evaluation.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Inservice Training--Organization and Administration (OG); New York City

Y014151 50
0304862 85079857 AHA
Diagnosis related group prospective payment: implications for health care and medical technology.
Davis K; Anderson G; Steinberg E
Health Policy, 1984, 4 (2) p139-47,
ISSN 0168-8510
Jrnl Code: HEPde:
Lang.: ENG.
Jrnl Ann.: 8504
Subfile: Health
This paper reviews the major features of the new DRG prospective payment system which was introduced for the payment of hospitals under the Medicare program October 1, 1983 in the United States. It explores its general implications for the health sector, and then examines its specific implications for the development, diffusion, and utilization of medical technology. It concludes with some of the research questions that require investigation to provide an informed basis for modification to the payment system that will ensure that quality health care will be provided at an affordable cost.
Tags: Support, Non-U.S. Gov't
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Diffusion of Innovation; *Financial Management--Trends (TD); *Financial Management, Hospital--Trends (TD); Health Services Research; *Reimbursement Mechanisms *Reimbursement, Prospective; Technology, Medical; United States

Y014151 51
0304777 85078105 AHA
How to select and implement case-mix (product-line analysis) systems.
Barnard C
Hosp Forum, Jan-Feb 1985, 28 (1) p25-30,
ISSN 0018-5663
Jrnl Code: GDE
Lang.: ENG.
Jrnl Ann.: 8504
Subfile: Health
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; Data Collection; Decision Making; *Hospitals; *Information Systems--Standards (ST); *Management Information Systems--Standards (ST)

Y014151 52
0301715 85050651 AHA
"There are differences in system capabilities..." [interview by Ken Kadash]
Trammell D
Comput Healthc, Dec 1984 5 (12) p46, 49,
ISSN 0745-1075
Jrnl Code: D98
Lang.: ENG.
Jrnl Ann.: 8503
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems; United States

Y014151 53
0300092 85055955 MED
The Medicare Prospective Payment System and the care of the frail elderly.
Berenson RA; Pawlson LG
J Am Geriatr Soc, Nov 1984, 32 (11) p843-8,
ISSN 0002-8614
Jrnl Code: H6V
Lang.: ENG.
Jrnl Ann.: 8503
Subfile: INDEX MEDICUS
The development of the Medicare Prospective Payment System based on diagnosis-relating groupings is reviewed. Special emphasis is placed on analysis of the provisions that have a potential impact on geriatric medicine and on the care of the frail elderly. The authors conclude that in its present form, the DRG system may systematically undercompensate hospitals for treating the frail elderly and, therefore, result in attempts by some hospitals to reduce or avoid altogether programs in geriatric medicine and admissions of frail elderly persons. These effects, together with federal and state efforts to limit nursing home and home care costs, may result in a major under-provision of care for the frail elderly and exclusion of clinical geriatric medicine from the medical care system.
Tags: Human
Desc.: Aged; Case Mix; Costs and Cost Analysis; COSTS; Economics, Hospital; *Health Insurance for Aged anv"Disabled, Title 18; *HEALTH INSURANCE FOR AGED *Health Services for the Aged; Health Services for the Aged--Economics (EC); Nursing Homes--Economics (EC); United States Dept. of Health and Human Services; HHS; United States

Y014151 54
0299306 85038097 AHA
A DRG-based manaement information system.
Burken MI
Pathologist, Nov 1984, 38 (11) p732-3,
ISSN 0031-3071
Jrnl Code: PAG
Lang.: ENG.
Jrnl Ann.: 8502
Subfile: Health
In the June 1984 issue of Pathologist Larry Shaw, MD, encouraged pathologists to turn threat into opportunity by coming partners with hospital management in addressing prospective payment challenges. He cited his own experience at Desert Samaritan Hospital and Health Center of Mesa, Ariz., as an example of how pathologists could participate in setting policy. The author of the following article shares yet another approach.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Hospital Dept.s--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); *Information Systems; *Management Information Systems; Maryland; *Pathology Dept., Hospital--Organization and Administration (OG); *PATHOL DEP--Organization and Administration (OG)

Y014151 55
0299261 85035659 AHA
We're scoring attendings by DRG.
Warnke RD
Med Econ, Nov 12 1984, 61 (23) p175-8, 183-5,
ISSN 0025-7206
Jrnl Code: MBN
Lang.: ENG.
Jrnl Ann.: 8502
Subfile: Health
Desc.: *Case Mix; *Cost and Cost Analysis; *COSTS; Hospital Bed Capacity, 300 to 499; HOSP BED CAPAC 300; *Information Systems; *Management Information Systems; *Medical Staff, Hospital--Standards (ST); Michigan; *Utilization Review--Economics (EC)

Y014151 56
0299125 85029898 AHA
Developing partnerships between physicians and healthcare executives.
Simendinger EA; Pasmore W
Hosp Health Serv Adm, Nov-Dec 1984, 29 (6) p21-35,
ISSN 0364-4553
Jrnl Code: G9T
Lang.: ENG.
Jrnl Ann.: 8502
Subfile: Health
Using an intensive interview methodology, this study examines factors that developed or destroyed cooperation in 10 physician-administrator management pairs. The data were collected from a six-multihospital system and another large sectarian teaching hospital. The factors studied included preconceptions, experiences prior to the formation of the pair, the emotional relationship between the two partners, and actions taken by one of the parties that affected the work of both. In general, physicians and administrators agreed more about factors promoting cooperation than factors destroying it. Moreover, few partners accurately assessed their counterparts' reactions to steps taken to promote cooperation. Most were unaware of behaviors reducing the willingness of the other to cooperate. Relationships improved or deteriorated based on beliefs by one partner about the other, rather than accurate perceptions of the other's behavior. The study is relevant to Diagnosis Related Groups (DRGs), the new federal financing mechanism for Medicare patients. Recent articles on Medicare's Prospective Payment System (PPS) predict conflicts between physicians and administrators as a result of the DRG program.
Tags: Human
Desc.: Case Mix; Conflict (Psychology); CONFLICT; Cooperative Behavior; *Health Facility Administrators--Psychology (PX); *Hospital Administrators--Psychology (PX); *Interprofessional Relations; *Medical Staff, Hospital--Psychology (PX); United States

Y014151 57
0299086 85029308 AHA
Responding to tough management issues.
McGeorge RK
Health Care (Don Mills), Oct 1984, 26 (7) p18-9,
ISSN 0226-5788
Jrnl Code: GKM
Lang.: ENG.
Jrnl Ann.: 8502
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospital Administration; Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Hospital Restructuring; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Ontario

Y014151 58
0299085 85029307 AHA
Keep track of information to cut costs.
Botz CK; Singh C
Health Care (Don Mills), Oct 1984, 26 (7) p14-5,
ISSN 0226-5788
Jrnl Code: GKM
Lang.: ENG.
Jrnl Ann.: 8502
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Information Systems; *Management Information Systems; Ontario

Y014151 59
0299042 85028882 AHA
Case mix: measuring productivity by monitoring resource consumption.
Pettigrew SL
HMQ, Fall 1984, p15-6,
Jrnl Code: GCA
Lang.: ENG.
Jrnl Ann.: 8502
Subfile: Health
Desc.: Arizona; *Case Mix; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management, Hospital; Health Resources--Utilization (UT); *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Multi-Institutional Systems--Economics (EC)

Y014151 60
0298948 8026765 AHA
Developing an information system for discharge planning under prospective pricing.
Fagan JL
Fisch Plann Update, Spring 1984, 4 (3) p5-9,
ISSN 0276-4652
Jrnl Code EBL
Lang.: ENG.
Jrnl Ann.: 8502
Subfile: Health
Desc.: Connecticut; Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); *Patient Discharge; *Reimbursement Mechanisms; *Reimbursement, Prospective

Y014151 61
0297336 85028152 MED
Univ. Hospital tries Medicus case mix analysis.
Hundert M; Stewart D
Dimens Health Serv, Sep 1984, 61 (9) p34-5, 48,
ISSN 0317-7645
Jrnl Code: E9N
Lang.: ENG.
Jrnl Ann.: 8502
Subfile: INDEX MEDICUS
Tags: Human
Desc.: *Case Mix; Cost Control; *Costs and Cost Analysis; *COSTS; Financial Management, Hospital; *Hospitals, Teaching--Economics (EC); *Hospitals, Univ.--Economics (EC); *Information Systems; *Management Information Systems; Ontario; Quality Assurance, Health Care; Task Performance and Analysis; TASK PERFORMANCE

Y014151 62
0296690 85005145 AHA
Case study. Using case-mix information for budgeting.
Plomann MP; Esmond T
Healthc Financ Manage, Oct 1984, 38 (10) p30-1, 34-5,
ISSN 0018-5639
Jrnl Code: GBC
Lang.: ENG.
Jrnl Ann.: 8501
Subfile: Health
The following case study illustrates the use of case-mix information in the budget process. Using case-mix data from a management information system such as PBCS, hospital managers can obtain the assistance of those who influence the delivery of care to develop a sound statistical budget upon which to allocate available resources. Such a budget should be based on honest goals which can be used to evaluate actual accomplishments.
Desc.: *Budgets; *Case Mix; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management, Hospital; *Information Systems; *Management Information Systems; United States

Y014151 63
0296689 85005144 AHA
Use of case-mix information in hospital management: an overview and case study.
Plomann MP; Bisbee GE Jr; Esmond T
Healthc Financ Manage, Oct 1984, 38 (10) p28-31, 34-6, 40-2,
ISSN 0018-5639
Jrnl Code: GBC
Lang.: ENG.
Jrnl Ann.: 8501
Subfile: Health
Desc.: *Accounting; *Case Mix; *Costs and Cost Analysis; *COSTS; Costs and Cost Analysis--Methods (MT); COSTS--Methods (MT); *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); United States

Y014151 64
0296646 85003080 AHA
Case-mix and computers: there's a micro-mainframe connection in your future. Part III--Effecting the micro-mainframe link-up: a technical perspective.
Jones R
Comput Healthc, Oct 1984, 5 (10) p36-9,
ISSN 0745-1075
Jrnl Code: D98
Lang.: ENG.
Jrnl Ann.: 8501
Subfile: Health
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; *Information Systems--Organization and Administration (OG); *Microcomputers ; United States

Y014151 65
0294218 84295186 AHA
Hospitals struggling to develop standards.
Nathanson M
Mod Healthc, Sep 1984, 14 (12) p140,
ISSN 0160-7480
Jrnl Code: NFAde:
Lang.: ENG.
Jrnl Ann.: 8412
Subfile: Health
Desc.: *Case Mix; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems--Standards (ST); *Reference Standards; United States

Y014151 66
0294213 84295181 AHA
Hospitals turn to new software, hardware to cope with DRGs.
Jackson B; Jensen J
Mod Healthc, Sep 1984, 14 (12) p109-12,
ISSN 0160-7480
Jrnl Code: ?FA
Lang.: ENG.
Jrnl Ann.: 8412
Subfile: Health
Desc.: *Case Mix; Computer programs; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems--Trends (TD); *Management Information Systems--Trends (TD); United States

Y014151 67
0293946 84287470 AHA
New system helps control quality and cost of medical care.
Hosp Top, Sep-Oct 1984, 62 (5) p10, 13,
ISSN 0018-5868
Jrnl Code: GD6
Lang.: ENG.
Jrnl Ann.: 8412
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems; *Management Information Systems; United States

Y014151 68
0293891 84287385 AHA
Beyond prospective payment: productivity in information management.
Jelinek RC
Healthc Comput Commun, Sep 1984, 1 (8) p37-8,
Jrnl Code: GBG
Lang.: ENG.
Jrnl Ann.: 8412
Subfile: Health
Tags: Human
Desc.: Efficiency; *Financial Management--Organization and Administration (OG); *Financial Management, Hospital--Organization and Administration (OG); *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG) ; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 69
0293886 84287380 AHA
An information system to support case mix management.
Cunningham ML; Splitstone GD
Healthc Comput Commun, Jul 1984, 1 (6) p77-80,
Jrnl Code: GBG
Lang.: ENG.
Jrnl Ann.: 8412
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Financial Management--Organization and Administration (OG); *Financial Management, Hospital--Organization and Administration (OG); Florida; Hospital Bed Capacity, 300 to 499; HOSP BED CAPAC 300; *Information Systems--Organization and Administration (OG); Planning Technics

Y014151 70
0293880 84287374 AHA
Data base technology. Community Memorial Hospital eases into prospective payment.
Bestor WE
Healthc Comput Commun, Jun 1984, 1 (5) p36-9,
Jrnl Code: GBG
Lang.: ENG.
Jrnl Ann.: 8412
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); Hospital Bed Capacity, 100 to 299; HOSP BED CAPAC 100; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); *Reimbursement Mechanisms--Organization and Administration (OG); *Reimbursement, Prospective--Organization and Administration (OG); Wisconsin

Y014151 71
0293871 84287365 AHA
Utilizing information systems to survive and prosper under prospective payment.
Turnage RB; Cook MJ
Healthc Comput Commun, Apr 1984, 1 (3) p20-4,
Jrnl Code: GBG
Lang.: ENG.
Jrnl Ann.: 8412
Subfile: Health
Desc.: *Hospitals; *Information Systems--Utilization (UT); *Management Information Systems--Utilization (UT); *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 72
0293807 84287264 AHA
Using MIS data for strategic planning.
Collier DJ
Health Care Strateg Manage, Jul 1984, 2 (7) p8-11,
ISSN 0742-1478
Jrnl Code: GAE
Lang.: ENG.
Jrnl Ann.: 8412
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems; *Management Information Systems; Planning Technics; United States

Y014151 73
0293785 84286109 AHA
How to cut costs under prospective payment systems.
Taibl DW
Food Manage, Aug 1984, 19 (8) p58,
ISSN 0091-018X
Jrnl Code: EZWde:
Lang.: ENG.
Jrnl Ann.: 8412
Subfile: Health
Desc.: *Food Service, Hospital--Economics (EC); Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); New Jersey; *Reimbursement Mechanisms; *Reimbursement, Prospective

Y014151 74
0291186 84275446 AHA
DRG strategies in the smaller hospital.
Bartek W
Tex Hosp, Jul 1984 40 (2) p16-7,
ISSN 0040-4357
Jrnl Code: WAL
Lang.: ENG.
Jrnl Ann.: 8411
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Hospital Bed Capacity, under 100; HOSP BED CAPAC UNDER 100; *Hospital Records--Economics (EC); *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); *Records--Economics (EC); United States

Y014151 75
0291061 84269954 AHA
Case mix management systems.
Bates SW; Hamilton RA; Clark JD
Mich Hosp, Aug 1984, 20 (8) p24-9,
ISSN 0026-220X
Jrnl Code: MXZde:
Lang.: ENG.
Jrnl Ann.: 8411
Subfile: Health
Desc.: *Case Mix; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS; Evaluation Studies; *Hospitals; *Information Systems; *Management Information Systems; Michigan; United States

Y014151 76
0290904 84263339 AHA
Computer eases prospective payment duties.
Beighley SK; Hernigle JR; Semrad TE
J Am Med Rec Assoc, Jul 1984, 55 (7) p51-3,
Jrnl Code: GJU
Lang.: ENG.
Jrnl Ann.: 8411
Subfile: Health
Desc.: *Computers; Hospital Bed Capacity, 100 to 299; HOSP BED CAPAC 100; *Hospital Dept.s--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); *Medical Records Dept., Hospital--Organization and Administration (OG); *MED REC DEP--Organization and Administration (OG); *Reimbursement Mechanisms; *Reimbursement, Prospective; Wisconsin

Y014151 77
0290846 84262937 AHA
Cluster approach allows budgeting, planning with DRGs.
Grimaldi PL
Hosp Prog, Jul-Aug 1984, 65 (7) p73-9,
ISSN 0018-5817
Jrnl Code: GD1
Lang.: ENG.
Jrnl Ann.: 8411
Subfile: Health
Measuring costs and revenues on a diagnosis related group (DRG) basis allows health care managers to define product lines, identify market shares, and examine the effects of case mix and physician behavior on profitability. It also enables public agencies to predict bed needs and evaluate certificate-of-need applications. The large number of DRGs, however, and other managerial considerations may discourage the use of DRG-based budgeting and planning. To save time and enhance data usefulness, financial officers may consolidate the DRGs into fewer groups. Revenue, for example, can be estimated by grouping the DRGs into 23 major diagnostic categories or by clustering them according to cost weight or into one group. Comparisons of payment rates and costs will identify the DRGs that lose money and will determine whether departmental costs are excessive. Strategic planning units formed from the 468 DRGs will help health care managers analyze and project performance. Product lines for this purpose may be clustered according to major diagnostic category, physician specialty, or clinical department. Since a potentially enormous amount of DRG-based clinical and financial information could be generated, hospitals should create data committees to ensure that managers receive only the information they need.
Desc.: *Budgets; *Case Mix; Cost Allocation; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); Management Information Systems; Reimbursement, Prospective; United States

Y014151 78
0290835 84262903 AHA
Severity data aid in hospital management.
Horn SD; Horn RA
Hosp Forum, Jul-Aug 1984, 27 (4) p55-60,
ISSN 0018-5663
Jrnl Code: GDE
Lang.: ENG.
Jrnl Ann.: 8411
Subfile: Health
Tags: Human
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); Information Systems--Organization and Administration (OG); Reimbursement, Prospective; United States

Y014151 79
0290819 84262810 AHA
The microcomputer alternative. A short-term approach to managing under PPS.
Annis RJ; Holton JW
Healthc Financ Manage, Aug 1984, 38 (8) p40-2, 48-50,
ISSN 0018-?639
Jrnl Code: GBC
Lang.: ENG.
Jrnl Ann.: 8411
Subfile: Health
Desc.: Chicago; *Computers; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); *Information Systems; *Management Information Systems; *Microcomputers; *Reimbursement Mechanisms ; *Reimbursement, Prospective

Y014151 80
0290712 84260902 AHA
A half century of commitment.
Arons RR
Comput Healthc, Aug 1984, 5 (8) p46-9, 52-3, 56,
ISSN 0745-1075
Jrnl Code: D98
Lang.: ENG.
Jrnl Ann.: 8411
Subfile: Health
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Hospitals; *Information Systems--Organization and Administration (OG); New York City

Y014151 81
0290711 84260901 AHA
Case-mix and computers: there's a micro-mainframe connection in your future. Part two: Deciding which delivery mode should do what. And why. And how.
Jones R
Comput Healthc, Aug 1984, 5 (8) p44-5,
ISSN 0745-?075
Jrnl Code: D98
Lang.: ENG.
Jrnl Ann.: 8411
Subfile: Health
Tags: Human
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; Decision Making; *Hospitals; *Information Systems--Organization and Administration (OG); *Microcomputers

Y014151 82
0290710 84260900 AHA
The single database advantage in prospective payment.
Chamness M Jr; Innmon C
Comput Healthc, Aug 1984, 5 (8) p40-2,
ISSN 0745-?075
Jrnl Code: D98
Lang.: ENG.
Jrnl Ann.: 8411
Subfile: Health
Desc.: *Hospitals; *Information Systems--Organization and Administration (OG); *Reimbursement Mechanisms; *Reimbursement, Prospective ; Texas

Y014151 83
0287238 84247292 MED
Nursing gears up for DRGs: management strategies.
Shaffer FA
NLN Publ, Jun 1984, (20-1959) p73-86,
Jrnl Code: O3Z
Lang.: ENG.
Jrnl Ann.: 8410
Subfile: Nursing
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Economics, Nursing; *Hospital Administration; Information Systems; *Nursing Service, Hospital--Organization and Administration (OG); Quality Assurance, Health Care; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 84
0287235 84247289 MED
Will your computer meet your case-mix informational needs
Fedorowicz J
NLN Publ, Jun 1984, (20-1959) p47-56,
Jrnl Code: O3Z
Lang.: ENG.
Jrnl Ann.: 8410
Subfile: Nursing
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Financial Management, Hospital; *Information Systems--Standards (ST); Management Information Systems--Organization and Administration (OG); United States

Y014151 85
0286999 84245724 MED
Will payment based on diagnosis-related groups control hospital costs
Wennberg JE; McPherson K; Caper P
N Engl J Med, Aug 2 1984, 311 (5) p295-300,
ISSN 0028-4793
Jrnl Code: NOW Contract/Grant No.: 1 ?01 HS 04932-01
Lang.: ENG.
Jrnl Ann.: 8410
Subfile: AIM; INDEX MEDICUS
Previous studies have shown that the admission rates for a few surgical procedures, such as hysterectomy, vary extensively among hospital market areas, apparently because of differences in physicians' practice styles. To see whether such variations occur for most causes of admission, we classified all nonobstetrical medical and surgical hospitalizations in Maine for the years 1980 through 1982 into diagnosis-related groups (DRGs) and measured the variations in admission rates among 30 hospital market areas. Hysterectomy rates varied 3.5-fold, but 90 per cent of medical and surgical admissions fell into DRGs for which admission rates were even more variable, suggesting that professional discretion plays an important part in determining hospitalization for most DRGs. Losses in hospital revenues resulting from the DRG payment system could be offset if physicians modified their admission policies to produce more profit, well within the current limits of medical appropriateness. If this occurred, the net effect of a DRG program would be to exacerbate hospital cost inflation. We conclude that, to be successful, cost-containment programs based on fixed, per-admission hospital prices will need to ensure effective control of hospitalization rates.
Tags: Human; Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.
Desc.: *Case Mix; Cost Control; *Costs and Cost Analysis; *COSTS; Data Collection; *Hospitalization--Economics (EC); Length of Stay; Maine; Patient Admission--Economics (EC); Physicians; Reimbursement Mechanisms; Statistics; Surgery, Operative

Y014151 86
0286628 84240973 MED
The impact of prospective payment: a multi-dimensional analysis of New Jersey's SHARE program.
Rosko MD
J Health Poli? Policy Law, Spring 1984, 9 (1) p81-101,
ISSN 0361-6878
Jrnl Code: IBC
Lang.: ENG.
Jrnl Ann.: 8410
Subfile: INDEX MEDICUS
The SHARE program, which set per diem prospective rates for New Jersey hospitals during the period 1975-1982, is evaluated. Analysis suggests that this program did contain hospital cost increase. However, the program threatened the viability of most inner-city hospitals. Indirect evidence suggests that there was cost-shifting in response to this program, which regulated payment for only Blue Cross and Medicaid patients. Structural features of this program and its successor, the New Jersey DRG program, are analyzed; and implications for the Medicare prospective payment system are examined.
Tags: Human
Desc.: Cost Allocation; Cost Control--Trends (TD); *Economics, Hospital--Trends (TD); Evaluation Studies; Hospitals, Municipal--Economics (EC); New Jersey; Rate Setting and Review--Trends (TD); RATE SETTING--Trends (TD); *Reimbursement Mechanisms--Trends (TD); *Reimbursement, Prospective--Trends (TD)

Y014151 87
0285420 84210864 AHA
Roundtable discussion: the effect the new payment system has had on medical record management.
Kudirka G; Majerowicz AV; Durkin E; Johnson S; Terlep M
J Am Med Rec Assoc, May 1984, 55 (5) p39-40,
Jrnl Code: GJU
Lang. ENG.
Jrnl Ann.: 8409
Subfile: Health
Tags: Human
Desc.: Case Mix; *Hospital Dept.s--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); Management Information Systems; Medical Record Administrators; *Medical Records Dept., Hospital--Organization and Administration (OG); *MED REC DEP--Organization and Administration (OG); *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 88
0285418 84210862 AHA
Health care market experiences grouper software explosion.
Burda D
J Am Med Rec Assoc, May 1984, 55 (5) p35-7,
Jrnl Code: GJU
Lang.: ENG.
Jrnl Ann.: 8409
Subfile: Health
Prospective payment has created a need for PPS hospitals to assign patients to DRGs quickly and accurately. Vendors have responded with a flood of computer software that not only assigns DRGs, but also performs other sophisticated data collection functions. The array of software powers has confused many buyers over what their facilities should purchase. Important questions must be answered before investing hundreds or thousands of dollars on grouper software.
Tags: Human
Desc.: *Case Mix; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS; Decision Making; *Hospital Dept.s; *HOSP DEP; *Medical Records Dept., Hospital; *MED REC DEP; Reimbursement, Prospective; United States

Y014151 89
0285412 84210856 AHA
Executive message: competent medical record professionals are critical to successful management under the prospective payment system.
Barrett C
J Am Med Rec Assoc, May 1984, 55 (5) p14-5,
Jrnl Code: GJU
Lang.: ENG.
Jrnl Ann.: 8409
Subfile: Health
Tags: Human
Desc.: *Hospital Dept.s--Organization and Administration (OG) *HOSP DEP--Organization and Administration (OG); Management Information Systems; *Medical Record Administrators--Education (ED); *Medical Records Dept., Hospital--Organization and Administration (OG); *MED REC DEP--Organization and Administration (OG); Reimbursement, Prospective; United States

Y014151 90
0285373 84210527 AHA
Hospitals must stress communication to survive under prospective payment.
Copeland WM
Hosp Prog, May 1984, 65 (5) p41-3,
ISSN 0018-5817
Jrnl Code: GD1de:
Lang.: ENG.
Jrnl Ann.: 8409
Subfile: Health
As St. Francis-St. George opened its doors in January 1982 as a result of the merger of two former facilities, it faced numerous challenges to its ability to communicate with physicians, staff, and community. The previous hospitals had been sponsored by different congregations, the new facility had 50 fewer aggregate beds, and two sets of management personnel were competing for one set of positions. The communication initiatives taken to surmount these difficulties may prove helpful to other hospitals, for close communication--particularly with medical staffs--is essential in coping with the DRG system. To unsnarl the communications tangle at St. Francis-St. George, a committee was appointed to coordinate planning while also ensuring that each department maintained essential control over its own plans. Regular newsletters were published for hospital staff, physicians, managers, and the community. Monthly breakfasts and informal lunches provided for relaxed give-and-take discussions. In response to a December 1982 survey, many staff physicians, while expressing overall satisfaction with the hospital, also indicated that management and the board of trustees did not seem interested in the medical staff's views, that communication between management and physicians had been inadequate, and that the hospital's administration was more concerned with profits than with patient care. (ABSTRACT TRUNCATED AT 250 WORDS)
Tags: Human
Desc.: Communication; Health Facility Merger; *Hospital Administration; Hospital Bed Capacity, 100 to 299; HOSP BED CAPAC 100; Information Systems; Interprofessional Relations; *Medical Staff, Hospital--Organization and Administration (OG); Ohio; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States; Utilization Review

Y014151 91
0285182 84207395 AHA
Financial modeling: an administrative tool of the highest level.
Zak EJ; Harry RL
Comput Healthc, Jun 1984, 5 (6) p24-6,
ISSN 0745-1075
Jrnl Code: D98
Lang.: ENG.
Jrnl Ann.: 8409
Subfile: Health
Desc.: *Case Mix; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management, Hospital; Management Information Systems; *Models, Theoretical; Planning Technics; United States

Y014151 92
0284914 84228716 MED
The Medicar prospective payment system.
Scott SJ
Am J Occup Ther, May 1984, 38 (5) p330-4,
ISSN 0272-9490
Jrnl Code: 3O?
Lang.: ENG.
Jrnl Ann.: 8409
Subfile: INDEX MEDICUS
In 1983 Congress adopted the most significant change in the Medicare program since its inception in 1965. Along with measures to ensure the solvency of the Social Security System into the next century, Congress approved a system of prospective payment for hospital inpatient services, whereby hospitals are paid a fixed sum per case according to a schedule of diagnosis related groups (DRGs). The program will be phased in over a four-year period that began October 1, 1983. Several types of hospitals and distinct part units of general hospitals are excluded from the system until 1985, when Congress will receive a report on a method of paying them prospectively. Information used to calculate the DRG rates was published September 1, 1983, as part of the interim final regulations. Other third party payers, such as state Medicaid systems and insurance companies, are considering converting to this method of payment, and several have adopted it. The implications for occupational therapy include a greater emphasis on reducing hospital length of stay, expanding outpatient care, increasing productivity, and a trend toward documentation and accounting consistent with computer technology.
Tags: Human
Desc.: Case Mix; *Health Insurance for Aged and Disabled, Title 18--Economics (EC); *HEALTH INSURANCE FOR AGED--Economics (EC); Insurance, Health, Reimbursement; Length of Stay; Occupational Therapy Dept., Hospital--Economics (EC); OCCUP THER DEP--Economics (EC); *Reimbursement Mechanisms; Reimbursement Mechanisms--Legislation and Jurisprudence (LJ); *Reimbursement, Prospective; Reimbursement, Prospective--Legislation and Jurisprudence (LJ); United States

Y014151 93
0282515 84197360 AHA
How DRGs are changing the hospital's information needs.
Nackel JG
Trustee, May 1984, 37 (5) p24, 26, 28,
ISSN 0041-3674
Jrnl Code: WG9
Lang.: ENG.
Jrnl Ann.: 8408
Subfile: Health
Increased competition and the move to prospective pricing are rapidly changing the information needs of the hospital board and management. Data on the various "products" that the hospital provides are now needed to accurately assess the marketplace, as well as the performance of members of the medical staff and individual department managers within the hospital. The author discusses what specific produce line information is now needed and how the hospital can upgrade its information capabilities.
Tags: Human
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospital Dept.s--Economics (EC); *HOSP DEP--Economics (EC); *Information Systems; *Management Information Systems; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 94
0281283 84191404 MED
Decentralized management in a teaching hospital.
Heyssel RM; Gaintner JR; Kues IW; Jones AA; Lipstein SH
N Engl J Med, May 31 1984, 310 (22) p1477-80,
ISSN 0?28-4793
Jrnl Code: NOW
Lang.: ENG.
Jrnl Ann.: 8408
Subfile: AIM; INDEX MEDICUS
Tags: Human
Desc.: Budgets; Case Mix; Cost Allocation; Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; *Hospital Dept.s--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); *Hospitals, Teaching--Organization and Administration (OG); Management Information Systems; Maryland; Medical Directors; Nursing Service, Hospital--Organization and Administration (OG); Personnel Management--Methods (MT)

Y014151 95
0280577 84184210 MED
Financial information systems and the new reimbursement climate.
Knesper DJ
Hosp Community Psychiatry, Apr 1984, 35 (4) p327-9,
ISSN 0022-1597
Jrnl Code: GCJ
Lang.: ENG.
Jrnl Ann.: 8408
Subfile: INDEX MEDICUS
Tags: Human
Desc.: Budgets; Case Mix; Computer Programs; *Financial Management--Methods (MT); *Financial Management, Hospital--Methods (MT); *Information Systems; *Management Information Systems; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 96
0279889 84160448 AHA
Service intensity database: combining clinical and financial data.
Alfrey A; O'Donnell E
J Am Med Rec Assoc, Apr 1984, 55 (4) p22-6,
Jrnl Code: GJU
Lang.: ENG.
Jrnl Ann.: 8407
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Hospital Bed Capacity, 300 to 499; HOSP BED CAPAC 300; *Hospital Dept.s--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); *Medical Records Dept., Hospital--Organization and Administration (OG); *MED REC DEP--Organization and Administration (OG); Washington

Y014151 97
0279771 84158634 AHA
Diagnosis-related group prospective payment. Effects on medical quality assurance.
McMahon LF Jr
Eval Health Prof, Mar 1984, 7 (1) p25-41,
ISSN 0163-2787
Jrnl Code: ENK
Lang.: ENG.
Jrnl Ann.: 8407
Subfile: Health
The new system for hospital reimbursement, called "reimbursement by diagnosis-related group" (DRG), offers a unique opportunity for the development of novel approaches to quality assurance. Groups of medically similar patients with stable patterns of resource use have been defined. These groups form the basis of the new payment system. Patients whose care deviates from the norm of resource consumption for their group, so-called outliers, will need to be reviewed by the hospital's administrative and medical staff. Such outliers are likely to constitute different types of patients than those in their assigned group: (1) patients whose medical complexity precludes grouping because of limitations in the abstracted clinical data; (2) patients whose medical care deviated because of complications of therapy or inappropriate diagnostic and/or therapeutic interventions; (3) patients whose medical course is so unique that they would never fit any classification system. The DRG-based reimbursement system, then, will compel hospitals to review the care of these outliers. The rigorous examination of these patients and their care, although just a first step, should be a major boon to quality of care evaluations.
Tags: Support, Non-U.S. Gov't
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Hospitals; *Quality Assurance, Health Care; United States; Utilization Review--Standards (ST)

Y014151 98
0279750 84158018 AHA
Adapt or perish--can healthcare computerization assist institutional survival
Comput Healthc, Apr 1984, 5 (4) p30-5, 38,
ISSN 0745-1075
Jrnl Code: D98
Lang.: ENG.
Jrnl Ann.: 8407
Subfile: Health
Desc.: Case Mix; *Computers--Economics (EC); Cost Control--Methods (MT); *Health Facilities--Organization and Administration (OG); *Information Systems--Economics (EC); *Management Information Systems--Economics (EC); United States

Y014151 99
0278377 84164142 MED
DRG panic.
Neberg J; Wolff N
J Nurs Adm, Apr 1984, 14 (4) p17-21,
ISSN 0002-0443
Jrnl Code: JELde:
Lang.: ENG.
Jrnl Ann.: 8407
Subfile: AIM; INDEX MEDICUS
The authors describe the successful development and implementation of a multi-use nursing information system. Developed under the direction of nursing administration, this system serves as a database for statistical analysis, utilization review, and budget management. The intent of the article is to encourage nursing administrators with information systems to use them to the fullest possible extent.
Tags: Human
Desc.: *Administrative Personnel; *Case Mix; Colorado; *Computers; *Costs and Cost Analysis; *COSTS; Hospital Bed Capacity, 300 to 499; HOSP BED CAPAC 300; *Nurse Administrators; Nursing Care; *Nursing Service, Hospital--Economics (EC); Personnel Staffing and Scheduling; PERSONNEL STAFFING; Utilization Review

Y014151 100
0278041 84160191 MED
A PPS essential: case-mix management systems.
Jaggar FM; Pugliese DF
Hospitals, May 1 1984, 58 (9) p71-6,
ISSN 0018-5973
Jrnl Code: GDLde:
Lang.: ENG.
Jrnl Ann.: 8407
Subfile: AIM; INDEX MEDICUS
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; *Hospital Administration; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); United States

Y014151 101
0277997 84159865 MED
Confronting prospective payment: requirements for an information system.
Coulton CJ
Health Soc Work, Winter 1984, 9 (1) 13-24,
ISSN 0360-7283
Jrnl Code: FZ6
Lang.: ENG.
Jrnl Ann.: 8407
Subfile: INDEX MEDICUS
The introduction of prospective payment for hospital care will inevitably create new demands for information on the costs of services. This discussion of an information system that is responsive to the requirements of prospective payment demonstrates how hospital social work departments can improve their access to data and thereby increase their own effectiveness.
Desc.: Case Mix; *Hospital Dept.s--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Patient Discharge; *Reimbursement Mechanisms; *Reimbursement, Prospective; *Social Work Dept., Hospital--Organization and Administration (OG); United States

Y014151 102
0277402 84147338 AHA
Developing a case-mix strategy.
Lampiris L
South Hosp, Mar-Apr 1984, 52 (2) p64-70,
ISSN 0038-4178
Jrnl Code: VAB
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems--Organization and Administration (OG); Planning Technics; United States

Y014151 103
0277213 84141780 AHA
Group DRGs into 'product families' for better management and control
[news]
Benz PD
Mod Healthc, Mar 1984, 14 (4) p110, 114, 118,
ISSN 0160-7480
Jrnl Code: NFA
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems; *Management Information Systems; United States

Y014151 104
0277188 84141754 AHA
Computers can figure out DRGs, if you can figure out computer market.
Dorenfest SI
Mod Healthc, Feb 15 1984, 14 (3) p130, 134, 136,
ISSN 0160-7480
Jrnl Code: NFA
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Health
Desc.: *Case Mix; Computers; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems; *Management Information Systems; United States

Y014151 105
0277149 84141182 AHA
Prospective payment: how computers can help us cope.
Winkel P; Statland BE
MLO Med Lab Obs, Feb 1984, 16 (2) p33-8,
ISSN 0580-7247
Jrnl Code: MLS
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Health
Tags: Human
Desc.: *Computers; Efficiency; Hospitals; *Information Systems; Laboratories--Organization and Administration (OG); *Management Information Systems; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 106
0276961 84134278 AHA
Strategic information planning for the 1990's.
Macies JS
Health Care (Don Mills), Feb 1984, 26 (1) p22-3,
ISSN 0226-5788
Jrnl Code: GKM
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Health
Desc.: Canada; *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Planning Technics

Y014151 107
027694 84134248 AHA
Preparing for prospective payment. Part III: information systems.
Flanagan JB; Sourapas KJ
J Am Med Rec Assoc, Jan 1984, 55 (1) p11-5,
Jrnl Code: GJU
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Health
Desc.: Commerce; *Hospital Dept.s--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); *Information Systems; *Medical Records Dept., Hospital--Organization and Administration (OG); *MED REC DEP--Organization and Administration (OG); *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 108
0276903 84133930 AHA
Task force, staff education ease transition to prospective payment.
Annis RJ
Hosp Prog, Feb 1984, 65 (2) p50-2, 74,
ISSN 0018-5817
Jrnl Code: GD1
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Health
Columbus-Cuneo-Cabrini Medical Center prepared extensively for the Medicare prospective payment system (PPS), which went into effect there Jan. 1, 1984. Administrators believe the planning effected a smooth transition from the retrospective reimbursement system. Preparation took two froms: educational sessions for all staff and trustees and establishment of a Prospective Payment System Implementation Task Force to develop ways to deal with new problems. All staff and trustees attended educational sessions, which were tailored to address each group's specific concerns. The sessions compared the old and new systems and emphasized PPS's effects on the institution over three years. The financial staff also provided weekly written updates to administrators and physicians on financial issues, including PPS, regulations, and reimbursement. The medical center's task force consisted of eight "in-house experts" on PPS. Because they had to act quickly, they operated under unique ground rules: Communicate with each other. Ignore the chain of command. Believe any problem can be resolved. Believe conflict is good. As chairman, the vice-president of finance had the task of estimating PPS's impact on the institution. The medical records director was responsible for the case-mix management system. The utilization review director ranked physicians and DRGs according to their profitability. The data processing director was responsible for installation of the DRG information system. The controller, reimbursement director, and cost accounting manager developed ways to maintain accurate financial records. The director of patient care services developed and scheduled PPS education programs. As a result of the preparation, the medical center staff realizes the importance of cost control if the institution is to remain viable.
Tags: Human
Desc.: *Administrative Personnel--Education (ED); Chicago; Governing Board; *Medical Staff, Hospital--Education (ED); *Multi-Institutional Systems--Economics (EC); Professional Staff Committees ; *Reimbursement Mechanisms; *Reimbursement, Prospective; *Trustees--Education (ED)

Y014151 109
0276834 8413376 AHA
Part 3, Responding to PPS. How hospital managers should respond to PPS.
Averill RF; Kalison MJ; Sparrow DA; Owens TR
Healthc Financ Manage, Mar 1984, 38 (3) p72-6, 82-6,
ISSN 0018-5639
Jrnl Code: GBC
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management, Hospital; Management Information Systems ; *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 110
0276778 84133688 AHA
Productivity management within prospective payment: Part II--Management's response.
Cruden JE
Health Care Strateg Manage, Feb 1984, 2 (2) p22-5,
Jrnl Code: GAEe:
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Health
Desc.: *Efficiency; *Hospital Dept.s--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); Institutional Management Teams; Management Information Systems; Personnel Staffing and Scheduling; PERSONNEL STAFFING; Planning Technics; *Reimbursement Mechanisms; *Reimbursement, Prospective

Y014151 111
0276428 84152214 MED
Medicare hospital payment by diagnosis-related groups.
Vladeck BC
Ann Intern Md, Apr 1984, 100 (4) p576-91,
ISSN 0003-4819
Jrnl Code: 5A6
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: AIM; INDEX MEDICUS
On 1 October 1983, the Medicare system began a phased transition to a new payment method for hospitals based on uniform payments by diagnosis-related group (DRG). This article reviews the rationale for DRG-based reimbursement, describes the new Medicare system, and discusses its implications for hospitals, physicians, and hospital-physician relations. Although it is too early to evaluate its impact, this payment system will probably encourage more operational interaction between hospital administrators and organized medical staffs, and accelerate trends towards salaried service chiefs in community hospitals and greater external scrutiny of physicians activities.
Tags: Human
Desc.: Case Mix; *Health Insurance for Aged and Disabled, Title 18--Organization and Administration (OG); *HEALTH INSURANCE FOR AGED--Organization and Administration (OG); Hospital Administration--Economics (EC); Hospital Dept.s--Utilization (UT); HOSP DEP--Utilization (UT); *Insurance, Hospitalization--Organization and Administration (OG); Insurance, Physician Services--Organization and Administration (OG); Length of Stay; Medical Staff, Hospital--Economics (EC); *Reimbursement Mechanisms ; Reimbursement, Prospective; United States

Y014151 112
0275274 84143137 MED
Case mix management.
Halloran EJ; Kiley M
Nurs Manage, Feb 1984, 15 (2) p39-41, 44-5,
ISSN 0744-6314
Jrnl Code: OBV
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Nursing
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Information Systems--Organization and Administration (OG); *Nursing Service, Hospital--Organization and Administration (OG); United States

Y014151 113
0275204 84142919 MED
Nursing: gearing up for DRGs. Part II: Management strategies.
Shaffer FA
Nurs Health Care, Feb 1984, 5 (2) p93-9,
ISSN 0276-5284
Jrnl Code: N77
Lang.: ENG.
Jrnl Ann.: 8406
Subfile: Nursing
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Economics, Hospital; *Hospital Administration; Information Systems; Interprofessional Relations; Nursing Service, Hospital--Organization and Administration (OG) Organizational Innovation; Reimbursement, Prospective; United States

Y014151 114
0273826 84122453 AHA
Prospective payment and information management.
Marrett S
Tex Hosp, Nov 1983, 39 (6) p16-7,
ISSN 0040-4357
Jrnl Code: WAL
Lang.: ENG.
Jrnl Ann.: 8405
Subfile: Health
Desc.: *Hospitals; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); *Reimbursement Mechanisms; *Reimbursement, Prospective ; United States

Y014151 115
0273716 84116998 AHA
Management information systems and DRGs.
Hamilton RA
Mich Hosp, Oct 1983, 19 (10) p23-5,
ISSN 0026-220X
Jrnl Code: MXZde:
Lang.: ENG.
Jrnl Ann.: 8405
Subfile: Health
Desc.: *Case Mix; *Costs and CosTIVITY; SPACE COMMERCIALIZATION; SPACE MAINTENANCE
Sub. Class.: 7512 Astronautics--General (1975-)

Y014151 116
0273586 84111078 AHA
A practical perspective--case mix management: issues and strategies.
Nackel JG; Powell PD; Goran MJ
Hosp Health Serv Adm, Jan-Feb 1984, 29 (1) p7-14,
ISSN 0364-4553
Jrnl Code: G9T
Lang.: Eng.
Journ. Ann.: 8405
Subfile: Health
Tags: Human
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospital Administration; Management Information Systems; Medical Staff, Hospital; United States

Y014151 117
0271584 84099035 AHA
A look at how New Jersey's DRG system is changing board roles.
Ewell CM
Trustee, Jan 1984, 37 (1) p24, 28-9,
ISSN 0041-3674
Jrnl Code: WG9de:
Lang.: Eng.
Journ. Ann.: 8404
Subfile: Health
The board of trustees for New Jersey hospitals have undergone some dramatic changes since the state's DRG payment system was introduced three years ago. The author discusses what types of changes the hospitals' boards have experienced in the five general areas of their responsibility: management issues, medical issues, community responsibilities, strategic planning, and fiduciary responsibilities.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Governing Board; Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; New Jersey Organizational Innovation; Role

Y014151 118
0271313 84086368 AHA
Health care executive's guidebook to automation in the 1980s: health care information systems and DRGs.
Hosp Forum, Jan-Feb 1984, 27 (1) p23-30, 33, 36-42,
ISSN 0018-5663
Jrnl Code: GDE
Lang.: Eng.
Journ. Ann.: 8404
Subfile: Health
The key to effective decision-making in health care institutions--now and in the future--is data: accurate, reliable, well-understood information about your patients and about your institution's operations. Much of the data you need for decision support are now available in your financial, patient information, and departmental systems. To put it to work in ways that will meet the challenges of the 1980s, you need to develop more effective way to use this information. A decision-support system requires, above all, integrated data, flexible access, and the capability to extract and summarize relevant information from a mass of detail. Effective decision-support systems require powerful hardware and sophisticated software. Even more, they require planning and self-education on your part.
You must understand your current system and your future needs. You must also educate yourself about the computer market-place and the many systems options available to you. Read books and magazines, attend conferences contact vendors. Above all, talk to users of any system you are considering for your institution. The resources in this Guidebook can start you on your way.
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; Decision Making; Directories; *Information Systems; United States

Y014151 119
0269469 84086389 MED
Evaluating the new case-mix systems: a systematic approach.
Hulm C; Burik D
Hospitals, Jan 16 1984, 58 (2) p92, 94, 96,
ISSN 0018-5973
Jrnl Code: GDL
Lang.: Eng.
Journ. Ann.: 8404
Subfile: AIM; INDEX MEDICUS
Desc.: *Case Mix; Computer Programs; *Costs and Cost Analysis; *COSTS; Evaluation Studies; *Financial Management; *Financial Management, Hospital; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); United States

Y014151 120
0268848 84067780 AHA
Product orientation is key to success [news]
Nathanson M
Mod Healthc, Dec 1983, 13 (12) p38, 40,
ISSN 0160-74?0
Jrnl Code: NFA
Lang.: Eng.
Journ. Ann.: 8403
Subfile: Health
Desc.: *Case Mix; Costs and Cost Analysis; *COSTS; *Hospital Administration; *Information Systems; *Management Information Systems; United States

Y014151 121
0268605 84059742 AHA
Wise QA professionals will help create DRG data bases.
Hosp Peer Rev, Oct 1983, 8 (10) p125-6,
ISSN 0149-2632
Jrnl Code: GD0
Lang.: Eng.
Journ. Ann.: 8403
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Information Systems--Standards (ST); *Management Information Systems--Standards (ST); *Quality Assurance, Health Care; United States

Y014151 122
0268410 84057097 AHA
Using medical records to ensure fair DRG reimbursement.
Ray WJ; Johnstone J
Comput Healthc, Dec 1983, 4 (12) p32-6, 40,
ISSN 0745-1075
Jrnl Code: D98
Lang.: Eng.
Journ. Ann.: 8403
Subfile: Health
Desc.: *Admitting Department, Hospital--Organization and Administration (OG); *ADMIT DEP--Organization and Administration (OG); *Case Mix; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS ; *Hospital Departments--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); Management Information Systems; *Reimbursement Mechanisms--Methods (MT); *Reimbursement, Prospective--Methods (MT); United States

Y014151 123
0268111 84077042 MED
Developing reports.
Nold EG
Am J Hosp Pharm, Nov 1983, 40 (11) p1968-75,
ISSN 0002-9289
Jrnl Code 3I0
Lang.: Eng.
Journ. Ann.: 8403
Subfile: INDEX MEDICUS
The development and uses of reports for hospital pharmacy financial management are described. The source of the data and the availability, characteristics, and primary uses of each financial report are discussed. The reports deal with weekly, monthly, and fiscal-year-to-date drug expenses, monthly drug expenses by hospital cost center, monthly personnel expenses, and monthly revenue. Other reports that examine drug expenses, workload, and revenue in terms of patient days and number of hospital admissions are presented. A proposed drug use by diagnosis-related group
(DRG) report is included. The development and use of hospital pharmacy financial reports will enhance the manager's ability to improve or maintain services.
Desc.: Costs and Cost Analysis; COSTS; Documentation; *Financial Management--Methods (MT); Hospital Bed Capacity, 300 to 499; HOSP BED CAPAC 300; *Hospital Records; *Pharmacy Service, Hospital--Economics (EC); *Records

Y014151 124
0267370 84068816 MED
Will your computer meet your case-mix informational needs
Fedorowicz J
Nurs Health Care, Nov 1983, 4 (9) p493-5,
ISSN 0276-5284
Jrnl Code: N77
Lang.: Eng.
Journ. Ann.: 8403
Subfile: Nursing
Desc.: *Case Mix; Computers; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management, Hospital; Health Insurance for Aged and Disabled, Title 18--Legislation and Jurisprudence (LJ); HEALTH INSURANCE FOR AGED--Legislation and Jurisprudence (LJ); *Information Systems--Standards (ST); *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 125
0266774 84060925 MED
Hospital information systems: are we ready for case mix applications
Fedorowicz J
Health Care Manage Rev, Fall 1983, 8 (4) p33-41,
ISSN 0361-62?4
Jrnl Code: G11
Lang.: Eng.
Journ. Ann.: 8403
Subfile: INDEX MEDICUS
Tags: Human
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; *Hospital Administration; *Information Systems--Organization and Administration (OG); Management Information Systems--Organization and Administration (OG); Reimbursement, Prospective; United States

Y014151 126
0265926 84043522 AHA
Managing DRGs: knowing what to cut--and when.
Keefe J; Dube P; Jollie W
Radiol Manage, Sep 1983, 5 (4) p2-6,
ISSN 0198-7097
Jrnl Code: QSJde:
Lang.: Eng.
Journ. Ann.: 8402
Subfile: Health
Medicare's new DRG prospective reimbursement is based upon a methodology diametrically opposed to the incentives of its traditional retrospective, cost-based system. The agreement to a phase-in period for DRGs, with reimbursements based on both the cost-based and DRG-based methodologies for three years, creates a fundamental conflict and unique managerial challenge for radiology and other hospital administrators. It means they must know both what to cut under DRGs and when to cut them during and after the phase-in.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospital Departments--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); Management Information Systems; *Radiology Department, Hospital--Organization and Administration (OG); *RADIOL DEP--Organization and Administration (OG); Reimbursement, Prospective--Legislation and Jurisprudence (LJ); United States

Y014151 127
0265373 84028091 AHA
Living with TEFRA--a DP managers travelogue.
Morton A; Stay CA
Comput Healthc, Nov 1983, 4 (11) p61,
ISSN 0745-1075
Jrnl Code: D98
Lang.: Eng.
Journ. Ann.: 8402
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospitals; *Information Systems--Trends (TD); *Management Information Systems--Trends (TD); United States

Y014151 128
0262369 84003835 AHA
Financial modeling/case-mix analysis.
Heck S; Esmond T
Comput Healthc, Jun 1983, 4 (6) p50-1, 54,
ISSN 0745-1075
Jrnl Code: D98
Lang.: Eng.
Journ. Ann.: 8401
Subfile: Health
The authors describe a case mix system developed by users which goes beyond DRG requirements to respond to management's clinical/financial data needs for marketing, planning, budgeting and financial analysis as well as reimbursement. Lessons learned in development of the system and the clinical/financial base will be helpful to those currently contemplating the implementation of such a system or evaluating available software.
Desc.: *Case Mix; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management, Hospital; *Information Systems; *Management Information Systems

Y014151 129
0262364 84003830 AHA
System strategies for case mix.
Barnard C
Comput Healthc, Jun 1983, 4 (6) p28-32,
ISSN 0745-1075
Jrnl Code: D98
Lang.: Eng.
Journ. Ann.: 8401
Subfile: Health
As a result of the advent of case-mix reimbursement, hospital data processing (DP) managers are facing new and increasing pressures for integrated financial and clinical computer systems. Those hospitals with the capability of merging data and producing rapid and responsive analytical reports are clearly going to be the best-prepared for the coming changes in the management of hospital operations. Much of a hospital's preparedness will depend on the DP staff and its planning, management and technical resources.
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management, Hospital; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Medical Records Department, Hospital; MED REC DEP; United States

Y014151 130
0262052 84021023 MED
Hospital survival strategies for the 1980s.
Bonney RS
Am J Hosp Pharm, Sep 1983, 40 (9) p1483-8,
ISSN ?002-9289
Jrnl Code: 3I0
Lang.: Eng.
Journ. Ann.: 8401
Subfile: INDEX MEDICUS
Survival strategies for hospitals and hospital pharmacy departments are presented, and one hospital's development into a health-services system is described. Financial and competitive pressures are forcing institutions to develop new strateges for survival. The primary institutional strategy is diversification--both horizontal and vertical. Diversification can assist in the hospital's growth, increase its asset and revenue bases, and lead to the development of a health-care delivery system. Marketing to physicians and developing information systems are also critical strategies under a prospective payment system. Institutions will need to know the cost of providing care for specific diagnosis-related groups. Strategies must be employed to develop incentives to reduce inpatient acute-care services and to increase productivity. Physicians should be involved in all of the institutional strategies. Strategies for the pharmacy department are basically the same. Pharmacy departments should develop programs to reduce drug use especially antibiotic use) and information systems that show the actual cost of providing services by diagnosis. The major corporate restructuring and diversification efforts of one hospital are described. The future of hospitals and pharmacy departments will depend on the successful application of the strategies discussed.
Desc.: Case Mix; Economic Competition; *Hospital Administration--Trends (TD); Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; Information Systems; Marketing of Health Services; Missouri; Pharmacy Service, Hospital--Trends (TD); Research; United States

Y014151 131
0259939 83297222 AHA
Hospital information systems: computers crank out DRG cost data, but how valid is information
Nathanson M
Mod Healthc, Sep 1983, 13 (9) p160, 162, 164,
ISSN 0160-7480
Jrnl Code: NFA
Lang.: Eng.
Journ. Ann.: 8312
Subfile: Health
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Data Collection--Standards (ST); *Hospitals; *Information Systems; *Management Information Systems; United States

Y014151 132
0259938 83297221 AHA
Hospital information systems: computer must track patient costs.
Gillette PE
Mod Healthc, Sep 1983, 13 (9) p154, 156, 158,
ISSN 0160-748
Jrnl Code: NFA
Lang.: Eng.
Journ. Ann.: 8312
Subfile: Health
Desc.: *Case Mix; *Computers; *Costs and Cost Analysis; *COSTS; *Hospital Administration--Trends (TD); *Information Systems; *Management Information Systems; United States

Y014151 133
0257327 83288103 MED
Case mix management: one approach revealed.
deMora J; Legros G; McGeorge RK
Dimens Health Serv, Jul 1983, 60 (7) p27-9,
ISSN 0317-7645
Jrnl Code: E9N
Lang.: Eng.
Journ. Ann.: 8312
Subfile: INDEX MEDICUS
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Financial Management; *Financial Management, Hospital; Management Information Systems ; Ontario

Y014151 134
0256690 83270796 AHA
Data management from a manager's perspective.
McVeety JA
Mich Hosp, Aug 1983, 19 (8) p17-9,
ISSN 0026-220X
Jrnl Code: MXZde:
Lang.: Eng.
Jrnl Ann.: 8311
Subfile: Health
Desc.: Costs and Cost Analysis; COSTS; *Hospital Administration; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Reimbursement, Prospective; United States

Y014151 135
0251564 83236856 MED
The Hospital Capitation Payment Project: new incentives and tools for cost containment.
Elliott WB; Strand HM; Meyers FH; Getson JR; Paulson C; Hill JE; Hennings MN; Newman JF; Raichel TM
Inquiry, Summer 1983, 20 (2) p114-20,
ISSN 0020-1731
Jrnl Code: GO?
Lang.: Eng.
Journ. Ann.: 8310
Subfile: INDEX MEDICUS
Blue Cross of North Dakota, Blue Cross of Massachusetts, and the Blue Cross and Blue Shield Association, along with 10 hospitals, developed and implemented the Hospital Capitation Payment Project as a novel approach for containing escalating hospital costs. The hospital is paid a prospective, fixed amount for each person covered; in exchange, it assumes responsibility to provide or pay for all covered services needed by that individual. This responsibility extends to payment for covered care provided by other hospitals. The new tools and incentives created by the program, notably an innovative management information system, are designed to help hospitals better manage the health care needs and related costs of a defined population.
Tags: Support, Non-U.S. Gov't
Desc.: *Blue Cross--Economics (EC); *Capitation Fee; Cost Control; *Economics, Hospital; *Fees and Charges; *FEES; *Insurance, Hospitalization--Economics (EC); Management Information Systems; Massachusetts; North Dakota; *Reimbursement Mechanisms; *Reimbursement, Prospective

Y014151 136
0251494 83236278 MED
Under cost per case, hospitals need to analize product performance.
Kukla SF; Bachofer HJ
Hospitals, Jul 16 1983, 57 (14) p77-80,
ISSN 0018-5973
Jrnl Code: GDL
Lang.: Eng.
Journ. Ann.: 8310
Subfile: AIM; INDEX MEDICUS
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Documentation; *Hospital Records--Standards (ST); *Information Systems--Trends (TD); *Management Information Systems--Trends (TD); *Records--Standards (ST); *Reimbursement Mechanisms; *Reimbursement, Prospective; United States

Y014151 137
0250344 83211588 AHA
Preventive medicine for hospital costs.
Young DW; Saltman RB
Har Bus Rev, Jan-Feb 1983, 61 (1) p126-33,
ISSN 0017-8012
Jrnl Code: GBE
Lang.: Eng.
Journ. Ann.: 8309
Subfile: Health
The reality of soaring health care costs has hospital administrators facing the prospect of mandatory state regulation or voluntary restraint on their financial expenditures. In either event whether formulated and implemented through external rate setting or internal cost containment, managers should be preparing to adjust their hospitals' management control systems to the emerging requirements of tighter budgetary limitations. The authors discuss the implications such cost-containment programs have for hospital control systems, identify the five cost-influencing variables that must be monitored, and consider the critical importance of incorporating attending physicians into the management control effort.
Desc.: Case Mix; *Cost Control--Methods (MT); *Hospital Administration; Management Information Systems--Economics (EC); Medical Staff, Hospital--Education (ED); United States

Y014151 138
0250338 83211568 AHA
Preparing for case mix: the role of data processing.
Barnard C
Healthc Financ Manage, Jun 1983, 37 (6) p57-70,
ISSN 0018-5639
Jrnl Code: GBC
Lang.: ENG.
Journ. Ann.: 8309
Subfile: Health
Desc.: Abstracting and Indexing; ABSTRACTING; Accounting; *Case Mix ; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS; *Financial Management *Financial Management, Hospital; Medical Records Department, Hospital; MED REC DEP; United States

Y014151 139
0244935 83173008 AHA
Case mix: Medicare's pitch for a new ball game in operational funding.
Bley CM; Nackel JG
Trustee, Apr 1983, 36 (4) p14-7,
ISSN 0041-3674
Jrnl Code: WG9
Lang.: Eng.
Jrnl Ann.: 8307
Subfile: Health
The impact of case mix management on hospitals will be directly related to the adequacy of information available to trustees, physicians, and management. The authors argue for the development of hospital information data base that links clinical, financial, and productivity information.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Health Insurance for Aged and Disabled, Title 18--Legislation and Jurisprudence
(LJ); *HEALTH INSURANCE FOR AGED--Legislation and Jurisprudence (LJ); *Hospitals; *Information System--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); *Reimbursement Mechanisms--Legislation and Jurisprudence (LJ); *Reimbursement, Prospective--Legislation and Jurisprudence (LJ); United States

Y014151 140
0243284 83165782 MED
The design of case-based hospital payment systems.
Berki SE
Med Care, Jan 1983, 21 (1) p1-13,
ISSN 0025-7079
Jrnl Code: LSM
Lang.: ENG.
Journ. Ann.: 8307
Subfile: INDEX MEDICUS
Reimbursing hospitals on the basis of treated cases, as in the New Jersey diagnosis-related groups (DRG) experiment, is equivalent to a centrally set pricing scheme, with all of its inherent difficulties. In addition to the problems of appropriate case definition, it is not obvious how hospitals should be classified to form reference groups for cost determination. Because empirically derived cost schedules are based on observed treatment patterns and resource use, they reflect variations in clinical appropriateness and quality and in resource use efficiency that characterize the system from which the data are drawn. If case-based schemes are to incorporate desirable performance incentives, they must be much better specified and take into account the complexity of hospital behavior. This article identifies the basic components of case-based systems of hospital reimbursement and discusses the analytic and empiric problems involved in their design.
Desc.: *Case Mix; Cost Allocation; *Costs and Cost Analysis; *COSTS ; *Economics, Hospital; Efficiency; Financial Management, Hospital; New Jersey; *Reimbursement Mechanisms--Organization and Administration (OG); *Reimbursement, Incentive--Organization and Administration (OG); United States

Y014151 141
0241834 83130905 AHA
Development of a case mix information system.
Lewis J; Maupin G; O'Donnell E; Sauer A
Comput Healthc, Feb 1983, 4 (2) p36-41,
Jrnl Code: D98
Lang.: Eng.
Journ. Ann.: 8306
Subfile: Health
Tags: Support, Non-U.S. Gov't
Desc.: *Case Mix; *Computer Programs; *Computers; *Costs and Cost Analysis; *COSTS; Hospital Bed Capacity, 300 to 499; HOSP BED CAPAC 300; *Hospital Departments; *HOSP DEP; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); *Medical Records Department, Hospital; *MED REC DEP; Patient Credit and Collection; PATIENT CREDIT; Patient Discharge; Washington

Y014151 142
0239873 83133969 MED
Managers wanted. Case mix reimbursement demands managers, not facilitators.
Mannisto M
Hospitals, Mar 16 1983, 57 (6) p91-3,
ISSN 0018-5973
Jrnl Code: GDL
Lang.: Eng.
Journ. Ann.: 8306
Subfile: AIM; INDEX MEDICUS
Desc.: *Case Mix; *Costs and); *Financial Management, Hospital--Trends (TD); *Information Systems; *Management Information System; Reimbursement, Prospective; United States

Y014151 143
0239870 83133966 MED
Getting to know us. Hospitals may finally learn about true cost and pricing.
Friedman E
Hospitals, Mar 16 1983, 57 (6) p74, 78-82,
ISSN 0018-5973
Jrnl Code: GDL
Lang.: Eng.
Journ. Ann.: 8306
Subfile: AIM; INDEX MEDICUS
Tags: Human
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Efficiency; *Financial Management; *Financial Management, Hospital; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); Medical Records Department, Hospital--Organization and Administration (OG); MED REC DEP--Organization and Administration (OG); Patient Credit and Collection; PATIENT CREDIT; Reimbursement, Prospective; United States

Y014151 144
0235137 05005315 NP/021366
Prospective Reimbursement System Based on Patient Case-Mix for New Jersey Hospitals -- 1976-1983.
Sponsor (s): New Jersey State Dept. of Health, Trenton. Health Care Financing Administration, Washington, DC., Dec 1978, 318 p. Contract/Grant No.: PHS?HCFA-600-77-0022 NTIS Order No.: HRP-0029375
Lang.: Eng.
Doc Type: Technical Report
Journ. Ann.: 8305
A system of prospective reimbursement for hospitals in New Jersey, based on their patient case mix is described. It is envisioned that the integration of reimbursement, quality, and planning and the issuance of management reports will permit the observation and monitoring of the system. Such monitoring will provide various types of information for different purposes, including utilization review, licensing, reimbursement, and coordination. The success of implementing the case-based prospective reimbursement approach depends on recognition by all participants that it is viable and cost-effective. Tasks in system development for the period from 1976 to 1983 focus on the collection of a standard data set on patient data, claims, billing, cost reporting, computer processing, rate setting, development of statewide cost standards, generation of management reports, data reliability and uniformity, linkages between demographic and epidemiological data, institutional quality assessment, assessment of ancillary service resource use, nursing studies (diagnosis and resource use), patient care resource use, cost-volume relationships in patient care, and payment methodology (budget projections in terms of equalization, economic factors, and certificate of need). The New Jersey State Department of Health receives medical discharge abstracts from all acute care hospitals in the State, and selected variables from these abstracts are employed to categorize case into medically meaningful and statistically stable diagnosis-related groups by means of a patient classification scheme referred to as AUTOGRP. The ultimate goal of the system of prospective reimbursement is to encourage better hospital management through the provision of basic management information to hospital administrators. Tables and figures are included.
Desc.: New Jersey; *Reimbursement, Prospective; *Patients; Diagnosis; Data Collection; *Systems Analysis; Classification; Hospitals

Y014151 145
0234442 05004620 NP/014405
Medicaid Management Information System: Computer Decision Code for Automatic Claim Payment.
Sponsor (s): Nebraska Hospital Association, Lincoln., 1975, 36 p. NTIS Order No.: SHR-0001047 See also related documents, SHR-0001031 - SHR-0001046, SHR-0001048, SHR-0001049.
Lang.: Eng.
Doc Type: Technical Report
Journ. Ann.: 8305
This document provides supporting documentation for an evaluation of the Medicaid Management Information System of the Nebraska Department of Public Welfare, (SHR-0001031). A list of exception codes used by the Nebraska Department of Public Welfare in their utilization and monitoring functions under Title XIX is presented.
Desc.: *Medical Assistance, Title 19; *Computers; Nebraska; *Reimbursement Mechanisms

Y014151 146
0234437 05004615 NP/014399
Supplier Handbook.
Sponsor (s): Nebraska State Dept. of Public Welfare, Lincoln. 1975, 40 p. NTIS Order No.: SHR-0001041
See also related documents, SHR-0001031 - SHR-0001040, SHR-0001042 - SHR-0001049.
Lang.: Eng.
Doc Type: Technical Report
Journ. Ann.: 8305
This handbook provides supporting documentation for an evaluation of the Medicaid Management Information System of the Nebraska Department of Public Welfare (SHR-0001031). Provider agreement, medical care standards, and prior authorization are discussed, and a sample prior authorization document is presented. Other subjects examined include: services rendered outside Nebraska; freedom of choice and documentation of services; lock-in procedure; approval, maximum fees, and payment in full; procedures and codes; and Medicare / Medicaid. Instructions for completing forms are given, and paid claims listing and claim adjustment are discussed.
Desc.: *Manuals; Nebraska; Health Insurance for Aged and Disabled, Title 18; HEALTH INSURANCE FOR AGED; *Medical Assistance, Title 19; Reimbursement Mechanisms; Insurance Claim Reporting; *Health Services--Economics (EC)

Y014151 147
0234435 0500461 NP/014397
Instructions to Pharmacists.
Sponsor (s): Nebraska State Dept. of Public Welfare, Lincoln., 1975, 218 p. NTIS Order No.: SHR-0001039 See also related documents, SHR-0001031 - SHR-0001038, SHR-0001040 - SHR-0001049.
Lang.: Eng.
Doc Type: Technical Report
Journ. Ann.: 8305
Instructions to pharmacists are presented as supporting documentation for an evaluation of the Medicaid Management Information System of the Nebraska Department of Public Welfare (SHR-0001031). Information provided includes: instructions concerning eligibility of recipients; drugs and supplies; nursing home policy; quantity limitations; pricing; and instructions concerning completion of forms. Also included are a list of drug codes and a list of doctors and dentists.
Desc.: *Manuals; *Medical Assistance, Title 19; Nebraska; Reimbursement Mechanisms; Insurance Claim Reporting; *Pharmaceutical Services--Economics (EC)

Y014151 148
0232857 05003035 NP/007049
Hospital Information Systems in the Province of Quebec. Working Paper
Dumbaugh KA
Sponsor (s): Harvard Center for Community Health and Medical Care, Boston, Mass. Social Security Administration, Washington, D.C. Div. of Health Insurance Studies., Jan 1976 111 p. NTIS Order No.: HRP-0013110
Lang.: Eng.
Doc Type: Technical Report
Journ. Ann.: 8305
The information system used by the Canadian Province of Quebec as the basis for its hospital reimbursement and planning activities is analyzed, with a view toward implications for hospital rate setting in the United States. The kinds of information being collected in Quebec are documented in detail, the manner in which the information systems were designed and are used is described, and problems are pointed out. The division of decisionmaking powers between the Federal and Provincial governments in regard to information specification and reporting as noted. The bulk of information in the Quebec system flows from hospitals to the Ministry of Social Affairs, the government's planning and accreditation body. The information consists of financial data, resource complexity information, overall output data by activity centers in hospitals, structural measures of quality and efficiency of care, and other information. The data gathering mechanism generally follows criteria established by a government commission for judging the quality of data: that the information be pertinent, valid, accurate, provide continuity, and be accessible, efficient, and functional. The Ministry continuously applies cost / effectiveness principles to determine whether a particular set of data should be acquired routinely or on an ad hoc basis. Achievements of the system are said to be its flexibility and its effectiveness in allowing the Ministry to carry out its routine operations. Recommendations stemming from the analysis of the Quebec system are presented. Flowcharts and supporting documentation are provided.
Desc.: Quebec; *Rate Setting and Review; *RATE SETTING; *Information Services; *Economics, Hospital; *Reimbursement Mechanisms

Y014151 149
0230805 05000983 NP/02?983
Perspectives on Medicaid Management.
Hale G; Matheson B; Wilhelm M; Blackman E
Sponsor (s): Health Care Financing Administration, Washington, DC. Medicaid Bureau., Apr 1978, 95 p. NTIS Order No.: SHR-003815
Lang.: Eng.
Doc Type: Technical Report
Journ. Ann.: 8305
Viewed as a joint Federal / State effort, this publication disseminates various State solutions to Medicaid problems and presents innovative ideas and articles of general and special interest to State Medicaid managers and staff. New York State's recently implemented Long Term Care Home Health Care Program is described as a single - entry, single - source system providing Medicaid patients with a noninstitutional choice for long - term care. Nebraska's solution to Medicare crossover claims is presented as offering possibilities for other Medicaid programs in their efforts to be the ''last payor.'' A Washington economist examines the ''average cost per visit'' reimbursement approach used for visiting nurse services in his State and offers a new perspective. The Massachusetts Cost - Effectiveness Project is described, noting the lessons learned from this project. The third in a series of four excerpts from the Urban Institute's cost - containment reports analyzes long - term care reimbursement. The administrator of the Health Care Financing Administration discusses the importance of Medicaid management information systems to Medicaid program managers and stresses a new approach for the system: outcome - oriented performance standards. A research and demonstration activity report is included, along with an annotated bibliography.
Desc.: *Medical Assistance, Title 19--Organization and Administration (OG); New York; Massachusetts; Nebraska; Long Term Care--Economics (EC); *Reimbursement Mechanisms

Y014151 150
0229490 83107084 AHA
Case-mix data system prepares hospitals for DRG based reimbursement.
Burik D; Gilroy P; Mastrangelo AJ
Hosp Prog, Feb 1983, 64 (2) p47-9, 72,
ISSN 0018-5817
Jrnl Code: GD1
Lang.: Eng.
Journ. Ann.: 8305
Subfile: Health
Desc.: *Case Mix Chicago; *Costs and Cost Analysis; *COSTS; Data Collection; *Financial Management; *Financial Management, Hospital Hospital Bed Capacity, 300 to 499; HOSP BED CAPAC 300; *Information Systems--Organization and Administration (OG); *Management Information Systems--Organization and Administration (OG); *Reimbursement Mechanisms; *Reimbursement, Prospective

Y014151 151
0225353 83081053 MED
DRG. Hospital organization improves.
Boerma H
Hospitals, Jan 16 1983, 57 (2) p50, 59,
ISSN 0018-5973
Jrnl Code: GDL
Lang.: Eng.
Jrnl Ann.: 8304
Subfile: AIM; INDEX MEDICUS
Tags: Human
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Efficiency; Management Information Systems--Organization and Administration (OG); New Jersey

Y014151 152
0212679 82243876 MED
Improved cost allocation in case-mix accounting.
Williams SV; Finkler SA; Murphy CM; Eisenberg J
Med Care, May 1982, 20 (5) p450-9,
ISSN 0025-7079
Jrnl Code: LSMde:
Contract/Grant No.: HS-02577
Lang.: Eng.
Journ. Ann.: 8211
Subfile: INDEX MEDICUS
Traditionally, many hospital costs have been allocated to patients using indirect measures that do not always reflect the value of the resources used to provide care. When, for example, costs are allocated by multiplying the patient's charges by the hospital's ratio of costs to charges, the allocated cost does not reflect actual cost because the hospital does not uniformly charge for services in proportion to their cost. The choice of method for cost allocation will be as important for the newly developed case-mix cost-accounting systems as it has been for traditional cost-accounting systems. To illustrate how the use of an indirect cost-allocation method might affect the output of a case-mix cost-accounting system, operating room, radiology and clinical laboratory costs were assigned to 106 hospitalized inguinal hernia patients in two diagnosis-related groups (DRGs) using both the hospital's existing cost-allocation method and a method that measures costs directly. Total costs and the costs in each department were significantly lower in each DRG using the direct method. It was concluded that patients in these two DRGs were being assigned more than the actual cost of their care with the existing cost-allocation method and, therefore, that the existing method prevented the case-mix accounting system from providing accurate management information.
Tags: Copmparative Study; Human; Support, Non-U.S. Gov't; Support, U.S. Gov't, Non-P.H.S.; Support, U.S. Gov't, P.H.S.
Desc.: *Accounting--Methods (MT); Adolescence; Adult; Aged; *Case Mix; *Cost Allocation--Methods (MT); *Costs and Cost Analysis; *COSTS; *Costs and Cost Analysis--Methods (MT); *COSTS--Methods (MT); Fees and Charges; FEES; Hernia, Inguinal--Economics (EC); Hospital Bed Capacity, 500 and over; HOSP BED CAPAC 500; Laboratories--Economics (EC); Middle Age; Models, Theoretical; Operating Rooms--Economics (EC); Pennsylvania; Pilot Projects; Radiology Department, Hospital--Economics (EC); RADIOL DEP--Economics (EC)

Y014151 153
0208443 82200120 MED
Data systems for case mix.
Lichtig LK
Top Health Care Financ, Summer 1982, 8 (4) p13-9,
ISSN 0095-3814
Jrnl Code: VVG
Contract/Grant No.: 600-77-0022
Lang.: Eng.
Journ. Ann.: 8209
Subfile: INDEX MEDICUS
Tags: Support, U.S. Gov't, P.H.S.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; Data Collection--Methods (MT); Documentation; *Information Systems--Organization and Administration (OG); Medical Records; United States

Y014151 154
0201?89 82130068 AHA
Coded data use in case mix analyses.
Giovanis TN
Top Health Rec Manage, Mar 1982, 2 (3) p77-84,
ISSN 0270-5230
Jrnl Code: WAD
Lang.: Eng.
Journ. Ann.: 8206
Subfile: Health
Desc.: *Abstracting and Indexing; *ABSTRACTING; *Case Mix; *Costs and Cost Analysis; *COSTS; Health Planning; *Information Systems; Maryland Professional Standards Review Organizations; PSRO; Rate Setting and Review RATE SETTING

Y014151 155 
0194386 82051850 AHA
Medical record data and uniform billing.
Lichtig LK
J Am Med Rec Assoc, Oct 1981, 52 (5) p39-45,
ISSN 0025-7486
Jrnl Code GJV
Contract/Grant No.: HCFA 600-77-0022
Lang.: Eng.
Journ. Ann.: 8203
Subfile: Health
Tags: Support, U.S. Gov't, P.H.S.
Desc.: *Case Mix; *Costs and Cost Analysis; *COSTS; *Hospital Departments--Organization and Administration (OG); *HOSP DEP--Organization and Administration (OG); Information Systems; *Insurance Claim Reporting; *Insurance; *Medical Records Department, Hospital--Organization and Administration (OG); *MED REC DEP--Organization and Administration (OG); New Jersey

Y014151 156 
0173669 81140400 MED
No clear direction for financial management and survival.
Aden GD
Hospitals, Apr 1 1981, 55 (7) p81-2, 87-9, 176,
ISSN 0018-5973
Jrnl Code: GDL
Lang.: Eng.
Doc Type: Review
Journ. Ann.: 8107
Subfile: AIM; INDEX MEDICUS
The 1980 literature on hospital financial management covered wide-ranging territory, from DRGs and reimbursement to capital management and competition. However, strategies for future survival remained unclear. (52 Refs.)
Desc.: *Economics, Hospital; *Financial Management; Rate Setting and Review; RATE SETTING; *Reimbursement Mechanisms; United States

Y014151 157 
0167763 81068367 AHA
Automated DRG systems: unanswered questions.
Fedorowicz J; Veazie S
Hosp Prog, Jan 1981, 62 (1) p54-5, 71,
ISSN 0018-5817
Jrnl Code: GD1
Lang.: Eng.
Journ. Ann.: 8104
Subfile: Health
Health care facilities seeking to prepare for a DRG-based or a similar case mix system may consider a range of options: microcomputers, shared computer services, a generalized data base management system.
Tags: Human
Desc.: *Computers; *Diagnosis; *Financial Management; Hospitals; *Information Systems; Patients--Classification (CL); *Reimbursement Mechanisms

Y014151 158 
0010796 75113957 MED
How to prepare for prospective reimbursement: a workable management information system for managers, department heads and administrators.
Shorr AS
Hosp Top, Mar-Apr 1975, 53 (2) p5, 7-8, 25-6 passim,
ISSN 0018-5868
Jrnl Code: GD6
Lang.: Eng.
Desc.: Economics, Hospital; *Hospital Administration; *Information Systems; Michigan