Rose-Marie Chaperon

Case Mix



Posted: Wednesday, December 09, 2009

by Rose-Marie Chaperon
Chaperon Consulting, LLC

The Medicare Prospective Payment System (PPS) was introduced by the federal government in October, 1983, as a way to change hospital behavior through financial incentives that encourage more cost-efficient management of medical care. Each Medicare patient is classified into a Diagnosis Related Group (DRG) according to information from the Medical Record that appears on the bill: Diagnoses and procedures must be documented by the attending physician in the patient's medical record. A DRG with a weight of 2.0000 means that charges were historically twice the average, a DRG with a weight of 0. 5000 was half the average. The average DRG weight for all of a hospitals Medicare volume is called the case mix index (CMI). When making comparisons among various hospitals or patient groups, the case mix index can be used to adjust indicators such as average charges. (Case mix adjusted average charges would be actual charges divided by the CMI. (Such adjustments are sometimes referred to as "Average charges for a weight of 1. 0000. ") The DRG classification system is a useful tool for managing inpatient quality measurements and operating costs. It groups patients by diagnostic category for analysis and provides several key measurements of resource utilization (e. g. average length of stay vs. published national averages) (American Hospital Directory, 2007) . Case-mix adjustment has a small impact on hospital ratings, but can lead to important reductions in the bias in comparisons between hospitals.

The variables that might impact the rates on the table are race, geographic location, and education: The most important case-mix variables are: hospital service (surgery, obstetric, medical), age, race (non-Hispanic black), education, general health status (GHS), speaking Spanish at home, having a circulatory disorder, and interactions of each of these variables with service.

REFERENCES

American Hospital Directory. (2007). Case Mix - Medicare Prospective Payment System. Louisville: AHD.

Rose-Marie Chaperon also works as a Director of Revenue Cycle for healthcare operations. Rose-Marie's experience is process improvement and redesigning patient access and patient financial services areas. Rose Marie is an exceptional A/R guru and has held many Business Office and Patient Financial Services positions throughout her twenty-year tenure in revenue cycle. She is a very proactive leader and the kind of person who can direct a group of people towards their goals. Rose Marie has experience with a variety of software systems and led three hospitals through a system conversion during her assignments there. Rose-Marie is a Certified Healthcare Access Manager (CHAM). Rose-Marie can be reached via e-mail: rosechaperon@hotmail.com or rchaperon@shenahaiti.org

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