Prospective casemix-based funding, analysis and financial impact of cost outliers in all-patient refined diagnosis related groups in three Belgian general hospitals

European Journal of Health Economics

Volumn 7, Issue 1, 2006, Pages 55-65

  Pirson, Magali ^a   Martins, Dimitri ^a   Jackson, Terri ^b   Dramaix, Michèle ^a   Leclercq, Pol ^a  

^a UNIVERSITÉ LIBRE DE BRUXELLES   (Belgium)

^b LA TROBE UNIVERSITY   (Australia)

Author keywords

All patient refined diagnosis related groups; Hospital costs; Hospital funding; Outliers; Prospective payment system

Indexed keywords

ARTICLE; BELGIUM; CASE MIX; DIAGNOSIS RELATED GROUP; DISEASE SEVERITY; FINANCIAL MANAGEMENT; GENERAL HOSPITAL; HEALTH CARE COST; HOSPITAL FINANCE; HOSPITALIZATION; INTENSIVE CARE UNIT; PRIORITY JOURNAL; PROSPECTIVE PAYMENT; RESOURCE MANAGEMENT;

ADULT; BELGIUM; DIAGNOSIS-RELATED GROUPS; FEMALE; FINANCIAL MANAGEMENT, HOSPITAL; HOSPITAL COSTS; HOSPITALS, GENERAL; HUMANS; LENGTH OF STAY; MALE; MIDDLE AGED; OUTLIERS, DRG; SEVERITY OF ILLNESS INDEX;

EID: 33644870719     PISSN: 16187598     EISSN: None     Source Type: Journal    
DOI: 10.1007/s10198-005-0331-0     Document Type: Article

References (34)

1. Closon MC, Maes N (1998) Réformes du système de financement des hôpitaux en Belgique. J Econ Med 1:69-82
2. Averill R, Goldfield N, Hughes J, Bonazelli J, McCullough E, Steinbeck B, Mullin R, Tangg A (2003) All patient refined diagnosis related groups (APR-DRGs) version 20.0. Methodology overview. 3M Health Information Systems
3. Jackson T (2001) Using computerised patient-level costing data for setting DRG weights: the Victorian (Australia) cost weight studies. Health Policy 56:149-163
4. Medicare Program (2003) Change in methodology for determining payment for extraordinarily high-cost cases (cost outliers) under the acute care hospital inpatient and long-term care hospital prospective payment systems. Fed Regist 68:34493-34515
5. König B, Toepfer T (2004) DRGs: the new course of therapy for German health care. McKinsey Health Eur 3:42-49
6. Cots F, Elvira D, Castells X (2003) Relevance of outlier cases in case mix systems and evaluation of trimming methods. Health Care Manag Sci 6:27-35
7. Oye RK, Bellamy PE (1991) Patterns of resource consumption in medical intensive care. Chest 99:685-689
8. Cots F, Elvira D, Castells X, Dalmau E (2000) Medicare's DRG-weights in a European environment: the Spanish experience. Health Policy 51:31-47
9. Beaver C, Yuejen Zhao, McDermid S, Don Hindle (1998) Casemix-based funding of Northern Territory public hospitals: adjusting for severity and socioeconomic variations. Health Econ 7:53-61
10. Bertges DJ, Zwolak RM, Deaton DH, Teigen C, Tapper S, Koslow AR, Makaroun MS (2003) Current hospital costs and Medicare reimbursement for endovascular abdominal aortic aneurysm repair. J Vasc Surg 37:272-279
11. Kovac SR, Christie SJ, Bindbeutel GA (1991) Abdominal versus vaginal hysterectomy: a statistical model for determining physician decision making and patient outcome. Med Decis Making 11:19-28
12. Epstein AM, Stern RS, Weissman JS (1990) Do the poor cost more? A multihospital study of patients' socioeconomic status and use of hospital resources. N Engl J Med 322:1122-1128
13. Cots F, Mercadé L, Castells X, Salvador X (2004) Relationship between hospital structural level and length of stay outliers. Implications for hospital payment systems. Health Policy 68:159-168
14. Tucker D, Dirico L (2003) Managing costly Medicare patients in the hospital. Geriatr Nurs 24:294-297
15. Cisar NS, Mitchell CA (2001) Development of a program to manage costly outliers. Clin Nurse Spec 15:25-33
16. Bingle JM (2001) The CNS: making cents out of costly outliers through nursing care. Clin Nurse Spec 15:24
17. Ahrens T (1999) Outlier management. Influencing the highest resource-consuming areas in acute and critical care. Crit Care Nurs Clin North Am 11:107-116
18. Cooney RN, Haluck RS, Ku J, Bass T, MacLeod J, Brunner H, Miller CA (2003) Analysis of cost outliers after gastric bypass surgery: what can we learn? Obes Surg 13:29-36
19. Burnett DM, Kolakowsky-Hayner SA, Gourley EV 3rd, Cifu DX (2000) Spinal cord injury "outliers": an analysis of etiology, outcomes, and length of stay. J Neurotrauma 17:765-772
20. Gold M, Snodgrass S (2001) Calculating pass-through and outlier payments under APCs. Healthc Financ Manag 55:54-57
21. Anonymous (2002) Conduct physician outlier analysis to gain control of costs. Capitation Manag Rep 9:36-43
22. Redelmeier DA, Bell CM, Detsky AS, Pansegrau GK (2000) Charges for medical care at different hospitals. Arch Intern Med 160:1417-1422
23. Beebe JC (1992) An outlier pool for Medicare HMO payments. Health Care Financ Rev 14:59-63
24. Keeler EB, Carter GM, Trude S (1988) Insurance aspects of DRG outlier payments. J Health Econ 7:193-214
25. Robinson ML (1988) FY 1989 PPS rules affect outliers, labor costs. Hospitals 62:16
26. Fantini MP, Cisbani L, Manzoli L, Vertrees J, Lorenzoni L (2003) On the use of administrative data-bases to support planning activities: the case of the evaluation of neonatal case-mix in the Emilia-Romagna region using DRG and APR-DRG classification systems. Eur J Public Health 13:138-145
27. Shen Y (2003) Applying the 3M all patient refined diagnosis related groups grouper to measure inpatient severity in the VA. Med Care 41:103-110
28. Van de Sande S, Bossens M, Parmentier Y, Gigot JF (2003) National survey on cholecystectomy related bile duct injury - public health and financial aspects in Belgian hospitals - 1997. Acta Chir Belg 103:168-180
29. Hosmer DW, Lemeshow S (200) Applied logistic regression, 2nd edn. Wiley: New York
30. Pirson M, Dramaix M, Leclercq P, Jackson T (2005) Analysis of cost outliers within APR-DRGs in a Belgian general hospital: two complementary approaches. Health Policy (in press)
31. Detsky AS, Stricker SC, Mulley AG et al. (1981) Prognosis, survival and the expenditure of hospital resources for patients in an intensive care unit. N Engl J Med 305:667-672
32. Wagner DR Knaus WA, Draper EA (1987) Identification of low-risk monitor admissions to medical-surgical ICUs. Chest 92:23-428
33. Rodrigues JM, Trombert-Paviot B, Martin C (2003) Tarification à l'activité dans les hôpitaux: les expériences étrangères peuvent-elles fournir des idées pour la réforme prévue pour 2004 en France? J Econ Med 1-2:81-84
34. Carter GM, Rumpel JD (1994) Cost estimates for cost outlier cases under Medicare's prospective payment system. Rand/UCLA/Harvard Centre for Health Care Financing Policy Research