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A research paradigm for severity for illness: issues for the diagnosis-related group system.

Gertman PM, Lowenstein S - Health Care Financ Rev (1984)

Bottom Line: 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.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.

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ABSTRACT
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.

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Severity of illness revisions: A research options paradigm
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f1-hcfr-84-supp-079: Severity of illness revisions: A research options paradigm

Mentions: To assist in illustrating how a DRG/severity of illness policy research program could be organized, Figure 1 shows a decision tree model for questions which might be explored in the PPS severity of illness revisions. The authors believe that the central issue structuring a practical severity of illness research paradigm is the amount and type of information available.


A research paradigm for severity for illness: issues for the diagnosis-related group system.

Gertman PM, Lowenstein S - Health Care Financ Rev (1984)

Severity of illness revisions: A research options paradigm
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195107&req=5

f1-hcfr-84-supp-079: Severity of illness revisions: A research options paradigm
Mentions: To assist in illustrating how a DRG/severity of illness policy research program could be organized, Figure 1 shows a decision tree model for questions which might be explored in the PPS severity of illness revisions. The authors believe that the central issue structuring a practical severity of illness research paradigm is the amount and type of information available.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

ABSTRACT
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.

Show MeSH
Related in: MedlinePlus