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CA' .IX DEFINITIO)N BY DRG - 68 - DRG 121 ACUTE MYOCARDIAL INFARCTION ,MEDICAL CAKE 1975 1976 CHANGE % CHANGE PATIENTS 267 ' , 315 48 17.98 TOTAL COST 736811.12 882896.69 146085.56 19.83 UNIT COST 2759.59 2802.85 43.25 1.57 DAILY COST 199.24 201.26 2.02 1.02 BED-DAYS 3698 4387 689 18.62 AVERAGE LOS 13.85 13.93 .08 .55 TOTAL CHARGES 820269.81 1042593.69 222323.87 27.10 AVERAGE CHARGE 3072.17 3309.82 237.65 7.74 COST/CHARGES . .89825 .84683 FINAL 1975 1976 CHANGE % CHANGE COST CENTER UNIT COST UNIT COST UNIT COST UNIT COST OIETARY 127.46 131.44 3.98 3.12 ADMITTING 20.48 22.45 1.97 9.61 BILLING 90.40 97.27 6.87 7.60 HOTEL 159.28 180.74 21.45 13.47 NURSING 702.26 681.49 -20.77. -2.96 INTERNS & RESIDENTS 72.23 71.51 -.73 -1.00 MEDICAL RECOROS 22.01 26.39 4.38 19.87 SOCIAL SERVICE 16.36 17.50 1.14 , 6.95 NEW 80RN CARE UNIT .O0 .00 .00 .00 INTENSIVE CARE UNIT 60.34 69.37 9.03 14.96 CORONARY CARE UNIT 636.73 509.58 -127.15. -19.97 OPERATING ROOM .00 .00 .00 .00 RECOVERY ROOM .00 .00 .00 .00 ANESTHESIOLOGY .00 .00 .00 .00 DELIVERY ROOM .00 .00 .00 .00 OIAGNOSTIC RADIOLOGY 70.77 86.87 16:10 22.75 RADIOISOT0?rS 3.68 4.55 .87 23.55 RADIATIC:; THERAPY .00 .00 .00 .00 LABORA.TORY 276.29 330.85 54.56 19.75 EEG .00 .00 .00 00 EKG 58.22 55.07 -3.15 -5.41 MED-SURG SUPPLIES 101.24 136.18 34.94 34.51 PHYSICAL MEDICINE 68.74 84.43 15.69 22.83 RESPIRATORY THERAPY 77.25 82.49 5.24 6.79 IV THERAPY 39.82 49.30 9.47 23.79 PHARMACY 156.03 165.38 9.35 5.99 OIALYSIS .00 .00 .00 .00 UROLOGY .00 .00 .00 .00 KIDNEY TRANSPLANT .00 .00 .00 .00 Fic. 4. Sample management reprt foracute myo(ardial infartion patients treated duringa 2-year period.
VoL XVIII. No. 2, Supplemnlent - 69 - which are not to be included in the deterinaintion of the SHARE reimbursemient rate, After salary rates have l)een "equalized" in order to avoid distortions due to geographic wage differentials, controllable c,sts are grouped into 3 clusters of cost centers to allow for trade-ot'ts in treatment modes. Hlospital peer groups are foried and cost screens are set tbr each cluster of ecost celiters iu ecaih peer , mnp. When a hospital's cliuster of cost centers itils these screeuis, each cost ceniter within each cluster is screened again within peer groups. Foriiulaute then ;arc appliet to determine any uinreasonalble costs in the base period that should be disaillowed. Atter a hospital's reasonable costs have bheen determined, a preliminary per diemi reinibursement rate is cletermitned for the hospital. The proposed SHARE per diemi is re-examined in an informal review, often followed by appeals to the Departiiient, and in some cases to the coutrts. Once the SHARE per dieli is finalized, it provides the basis of reimbursement except for certain year-end adjustments made for volume variance, actual inflation, and cost increases because of legal and approved management changes, such as Certificates of Need and Blue Cross contractuial adjustments. The essential feature of the SHARE methodology is "peer groutping." This regulator, ut Ihnique was developed in the utility tield, wherein like institutions are classified according to comparable attributes in order to apply "tair" standards and develop reasonable rates. Since hospitais :display inore complexity than single- !output industries such as electric, gas or 'telephone companies, the technisque has been applied not at the aggregate level but at the cost center level. It should I>e noted that the forin or unit of payment under the ¿:SHARE system is the per diem and that the basis of paymient is cost. Altlhoulgh the SIlAIBE reirilursemnent i,methodology in New Jersey attained sig- CASE MIX ACCOUNTING nificant accomplishments in bringing a certain amount of order to cost reporting by hospitals in the state, there are basic elements to the structure of hospital reinimbursement which remain problems and whikh SHARE is not equipped to address. The t'uñdamental problem in cost contaíinment is defining the appropriate taols tor measuiring reasonable efficiency and eftectiveness in the hospital setting. Accurate instruiments are needed to ineasture the level of productivity and efftctiveiess iii teris of both outputs aud inputs and to respond with the applropriite t'inancial incentives or disinceintives. The attempt to measuire and compare hospital efficiency at the cost-center level fails to recognize the role of case mtix iii determining hospital costs. Ditferences or lack of differences in hospital costs at the cost-ceniter level can ihe the result of different case mix compositions anid mnay not reflect dit'le elices in hospital productivity. Further, 'te quality or etfectiveness oft' care must hb; pn)perly identified and measured in order to eval uate accurately hospital productivity. Anialyses by cost center inmay tend to obscure rather than claritfy these problenis. The second limnitation of the SHARE approach is in the existence of financial disincentives to the delivery of high-quiality, appropriate and efficient care. It is no secret that the per diem fonn of payment tends to encourage longer lengths of stay. Furthermore, the length-of-stay incentive problem is compounded by the use of cost as a basis of reinibursement. The reasonalble mieasure of a hospital financial manager's effectiveness is his success in maximizing reimbursement. The more cost is increased, the greater the revenues. Costs can be skillt'ully redistrihuted over ditferent cost centers with the el.ct of escaping peer cost screens. Another problem for the regulator, and opportunity for the amnbitious financial manager, results from a systel¡ il¡ whicli somte paticnts L)pay costs and others pay charges, compoaunded be-
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- ii - liancock, W., D. Magerlein y
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FOREWORD These last years, PAHO wit
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Workshop .- Education in Operationa
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-3. The format of the workshop was
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-5- 2. Programs for bringing togeth
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II. R.commendations -7- A series of
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-9- there are technically trained i
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-11- and selected individuals who h
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-13- 6. In order to improve the qua
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-15- cnve!opment will typically be
Page 23 and 24: -17- 16. All participants sbould pr
Page 25 and 26: A. Short Courses -19- Short courses
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Page 29 and 30: Topic Introduction to Systems Analy
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Page 35 and 36: -29- problems. The graduate should
Page 37 and 38: -31- Lblo-w. Also given is that typ
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Page 41 and 42: - 35 - Acknowledgment The authors w
Page 43 and 44: ML ICAL CAE1 Februurl 1980, Vol. XV
Page 45 and 46: X;' VIII, No. 2. Suippllce,t - 39 -
Page 47 and 48: - 41 - dMLDICAL C.ARE '.Fcbrtanj 19
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Page 111 and 112: CREENLAND iT AL - 105 - TABLE 2. Fi
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Page 115 and 116: 160 I indicates the flow of patient
Page 117 and 118: 162 CONGESTION POINTS ANU CONTROL.A
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I MEREDITH - 119 - varying oulcome
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MEDICAL CARE ,arch 1981, Vol. XIX,
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%,I. XIX, No. 3 iclnts. It should d
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n'ol. XIX, No. 3 - 125 - tailed exa
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1 Vol. XIX. No. 3 - 127 - tant for
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Vi. .XIX, No. 3 - 129 - tom' s reco
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- 131 - A \ ,,1. XIX, No. 3 PEHFOHR
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V Xl. IX, No. 3 - 133 - PERFORMANCE
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- 135 - The fourth requirement is l
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- 137 - Systems and Procedures of P
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- 139 - 2. ldentify problemn areas
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c 1 '-a
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u. o a.- 1 W. LZi - 143 - c c S C.
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- 145 - Thc cu rrent appointmren t-
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- 147 - A pure block appointment sy
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- 149 - ihe future. It was discover
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- 151 -
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- 153 - Figui.'¢ VII. Patient Arri
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- 155 - sonnel working in positions
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- 157 - 17. Keep the time span of t
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- 159 - TABLE I: Pnmary DesklConsul
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.Recomme;tded systenz - 161 - .;any
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- 163 - system, there is nr'. :vste
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- 165 - - A major problem with such
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- 167 - T1c Iteole of Olieraionls R
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- 169 - Larry J. Shumc- Harvey Wolf
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- 171 - '- ionoal Heolth Ploanning
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- 173 - Regional Health Planning ar
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- 175 - Regio.,oi Health Planning w
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- 177 - Regionao rfeclth Planning l
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A^CJonoal neonah ronning 21. 1'. F.
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- .,1 - Programming, Budgeting, and
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- 183 - the health care industí ,
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- 185 - was apparently no scarcity.
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ut, u a. íL ._c E 0 t42 a .. 0m u
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plex stochastic distribution of arr
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- 191 cumulated according to any or
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- 193 - Step 2 represents the heart
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ÍA en .aa
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- 197 - analysis, forecasting, and
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Budgeting Attitudes - 199 - The pla
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- 201 Health Services Research most
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a. - 203 - Health Services Research
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- 205 - DESIGN OF ALTERNATIVE PROVI
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- 207 - 1. A change in the immigrat
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- 209 - accessibility of health car
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- 211 - dimensional graph to illust
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- 213 - Primary Care Health Service
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- 215 - different health and educat
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- 217 - The tasks that were rated "
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IC1 o -a - i - w im W..i C -J M. -
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0 z 0 u _ I- 0 Ut. I,, uj CD Q U- ,
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TABLE 3 TASK ANALYSIS OF MALNUTRITI
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11 - 225 - TASK ANALYSIS OF MALNUTR
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- 227 - 12. Reisman, A., F.Staub, B
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- 229 - METHODS Parameters Affectin
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- 231 - ~HNCOCK Fig. 1. Daily censu
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- 233 - HANCOCK Table 1. Parameters
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- 235 - Fig. 3. Maximum average occ
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- 237 - HANCOCK ET AL Fig. 4. Maxim
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- 239 - AECOCL. Table 2. Eflect of
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- 241 - HANCOCK Discussion ET AL Th
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#12 Estinating the Need for Additio
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Pri c= arvicc a ia Indina. - 245 -
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. 1' - - IIINDLE Algorithmn for Det
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- 249 - HINDLE that all tlie primar
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- 251 - HINDLE 6. Computc Mhe Avail
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- 253 - HINDLA Tablek Meamm of Zfic
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HINDLE Tr AL HIALTH falvCU - 255 -
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- 257 - HIiDLZ 26. Ado, An . ad L.
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- 259 - REISMIAN, DEAN, ESOOBUE, AG
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- 261 - REISMAN, DEAN, ESOGBUE, AGG
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- 263 - 1350 REISMiAN, DEAN, ESOOBU
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- 265 - REISMAN, DEAN, ESOOBUE, AGO
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- 267 - 1354 REISMAN, IEAN, ESOGCUE
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- 269 - William J. Abernothy and Jo
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- 271 - William J. Abernathy and Jo
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- 273 - William 1. Abernothy ond Jo
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- 275 - William J. Abrnarthy and Jo
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- 277 - William J. Abernathy and Jo
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- 279 - William J. Aberncthy and Jo
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- 281 - 642 William J. Abernathy an
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Decmand in Mintu és/Day Numnlber o
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Disposal System 326 IIstlic I,',i,
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i Trays 334 Colorful pattenis anid
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tiie, gency L:ghting 347 ,i',., .:.
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- 296 - REVEI.LE we believe to be t
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- 293 R£VELLE is apparent in light
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- 295 - REVEt.EI. ET AL. poSJcd pro
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- 297 - RM.VELLE EL AL. of faciliti
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REVELLE ET AL. HALTOI SERVICUS RESE
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REVELLE ET Al.. - 301 - Fig. 4. Ano
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- 303 - REVet. ¡T AL Act of 1973.
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- 305 - REVELLE possible within ilh
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- 307 - RLVELI.E 29- Khumawala. a.
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- 309 - assuring thal the maxinmum
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-311 - the implemented strategy he
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- 313 - analytical approximalions w
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- 315 - rcquired Ior shipping and o
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- 317 - Controlling ¡he system The
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- 319 - The light pen techniques ar
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- 321 - shipnients have to be on ro
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- 323 THE CREATER NEIW' YORK BLOOD
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_,~ .- - 3. 2- - TABLE 1. PATIENT C
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TABLE 3. MEDICAL INTENSIVE CARE UNI
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Nursing Stalf Level (i of nurss/day
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Table 1. Factors ¡i denad for medi
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e forecast. This section descijbcs
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ei, paid to these standards in cond
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O Emphasis u.on the explicit enumer
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*1 1 21 1 «i 1 1 1 1 - 331, -- For
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Therc are ihreec basic prcessecs fi
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- 343 - Forecasting Hcalth Care Ser
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#20 Jaime 1B. Henrs Rtxlnc. I.. Ro:
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- 347 - I v,'N ti.K 1tHm.pi.l !, t1
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Ra.fo.renem.. aid %.hs '. - 31!9 -
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; / larman u empirical research has
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I Klarman - >3 - benefits that for
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I Klaman Ctitena for Inchmion - 355
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IClarman - 37 - The prevailing tend
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1 Klarman Intargibl Benefits - .5 -
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Kllarman - 361 - thi prospects of r
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- 363 - Thua, it did not consider w
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I Klannan - 365 - again if the new
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Klarman - 367 - At the other pole,
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- 369 - seem worth exploring. Howev
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iKlarman - 371 - in the use of serv
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Kmnnan - 373 - REFERENCES 1. Havema
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- 375 - 59. Valr y, W. S. One eonoi
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- 377 - i aSll a _ . b, CuaMu L. L,
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WAHRNER ANI) I|UTTr)N The puroses I
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WARNER AND HUTfON - 381 - observers
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.AHNF:R AND IIl'TIoN - 383 - rare I
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WARNER AND HUTTrU., TABLE 1. Trenda
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W'AHNER AND IHUTTON - 387 - treatme
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AAHNER AND HU'TON - 389 - Several d
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WARNER AND HUTTON pal orientations
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w'ARNER AND UL'TTOit'u ' . N Engl I
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I,,qr *ir 'ilu.,i XV. Seplteri¡br
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In.lumin- i',)i.eIu XV. Seph.irhb'r
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In#unrvlVolutn XV. September 1978 h
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Problemas identificados - 401 - Dur
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Programas educativos 3 - 403 - 1. S
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- 405 - maestrfa, donde se supone q
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- 407 - presentación formal de inf
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- 409 - * Curso para ingenieros ind
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- 411 - ¢ 16. Hancock, W., D. Mage
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- 413 - 2. Barrenechea, J. J. La se
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- 415 - Curwso (8 a 16 horas) para
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- 417 - 4. Necesidades de los admin
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MOISES ARTEAGA DR. DAVID GOMEZ COVA
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