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Healthcare Payment Systems
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
In order to determine payment amounts, each hospital is assigned its own Medicare payment rate based on two national base payment rates for operation and capital expenses (called a blended rate).3 This blended rate is also influenced by several other factors, including but not limited to geography, resident and medical education costs, overhead costs, and average case mix index (CMI), which indicates the acuity level of patients cared for at that institution. This payment rate is also known as the Medicare standardized payment rate. This rate is used in the payment calculation for every Medicare beneficiary who receives care at that hospital during that year. Each patient is then assigned to a MS-DRG based on unique characteristics of that hospital stay. Both the hospital’s blended rate and the patient’s MS-DRG assignment are used in the calculation to determine the payment the hospital will receive.
Optimizing Antimicrobial Use and Combating Bacterial Resistance: Benchmarking and Beyond
Published in Robert C. Owens, Paul G. Ambrose, Charles H. Nightingale, Antibiotic Optimization, 2004
Sujata M. Bhavnani, Paul G. Ambrose
Irrespective of the measure of drug use chosen, it is important to select a denominator by which drug use can be normalized in order to make comparisons across institutions. The denominator is typically a measure of patient density to represent the potential number of patients that could be exposed. A common denominator is “1,000 inpatient days.” The total number of hospital beds is also a commonly used denominator, but given that occupancy rates may vary within an institution by year and across hospitals, calculating the total number of occupied beds (OB = total number of beds X average occupancy rate) is preferable. Also, when benchmarking individual hospital data to data from a peer group of hospitals for which the acuity of the patient population varies greatly (e.g., a group of hospitals that are similar in size but not type), adjusting the individual data by the case mix index (CMI) may be prudent. For example, equation 1 could be applied to expenditure data ($/OB) to adjust for CMI:
Health expenditure and cost containment in Ireland
Published in Elias Mossialos, Julian Le Grand, Health Care and Cost Containment in the European Union, 2019
The case-mix measure adopted by the Department of Health are Diagnosis Related Groups (DRGs).9 Every case treated by an acute hospital is assigned to one DRG. The grouping system currently in use in Ireland contains 492 DRGs. Assignment is based on primary diagnosis, secondary diagnosis, procedures performed, discharge status, age, and sex. These details are gathered from the Hospital In-Patient Enquiry (HIPE). By grouping the in-patient cases of each hospital into a set of DRGs, each hospital's workload can be analysed and compared in case-mix terms. The cost information needed to calculate the cost of each DRG comes directly from each hospital through the Specialty Costings programme run by the Department of Health. This programme gathers costs for each specialty area within hospitals, and data for ten cost centres are extracted. The cost centres include the intensive care unit, theatre, drugs, radiology, hotel costs, supplies, laboratory, physician, administration and other miscellaneous costs. These cost centres are allocated to DRGs, some on the basis of daily costs, others using a set of service weights (i.e. a set of relativities that express the expected use of services between DRGs). The activity and cost data are combined to calculate a case-mix index (CMI) for each hospital. The CMI represents a measurement of the costliness/complexity of each hospital relative to any other hospital in the sample. For example, a hospital with a CMI of 1.15 has a caseload which would be expected to cost 15 per cent more than the national average. Using the CMI, hospital budgets taking account of case-mix measurement are calculated. Adjustments are made using a blend of the hospital's own cost per case (85 per cent) and the average cost per case of all hospitals in the sample (15 per cent). For a review of the case-mix adjustment approach adopted by the Department of Health see Wiley, 1995.10
Hospitalization trends and chronobiology for mental disorders in Spain from 2005 to 2015
Published in Chronobiology International, 2021
Carlos Llanes-Álvarez, Carlos Alberola-López, Jesús M. Andrés-de-Llano, Ana I. Álvarez-Navares, M. Teresa Pastor-Hidalgo, Carlos Roncero, José R. Garmendia-Leiza, Manuel A. Franco-Martín
Case mix index (CMI) is a relative value assigned to a diagnosis-related group of patients in a medical care environment. The CMI value is used to determine the allocation of resources to care for and/or treat patients in the group. Admissions are classified into groups having the same condition (based on main and secondary diagnosis, procedures, age), complexity (comorbidity), and needs. These groups are known as Diagnosis Related Groups (DRG), or Resource Use Groups (RUG) (Davis and Rhodes 1988). The group with a higher CMI value was eating disorders (2.42), followed by bipolar disorder (1.35), psychosis (1.34), and depressive disorder (1.19) (Table 2). DRG pricing varies in terms of geographic variation (labor markets, etc.).
The direct and indirect effects of vancomycin-resistant enterococci colonization in liver transplant candidates and recipients
Published in Expert Review of Anti-infective Therapy, 2019
Sara Belga, Diana Chiang, Dima Kabbani, Juan G. Abraldes, Carlos Cervera
Webb et al. demonstrated that the presence of VRE infection and/or colonization resulted in increased cost of hospitalization when compared to the absence of VRE, in patients who share a low burden of illness [37]. Case-mix index (CMI) was used as a measure of severity of illness with CMI > 1 indicating above average disease severity. For patients with CIM < 3, VRE-positive patients had a significant increase in hospitalization cost when compared to those who were VRE-negative. On the other hand, in patients with a CMI of >3, there was no difference in cost when compared VRE-positive to the VRE-negative group [37].
Preventing unnecessary interhospital transfers to urban medical centers
Published in International Journal of Healthcare Management, 2020
Dat Le, Ziad Alfarah, Schawan Kunupakaphun, Pracha Eamranond
This also led to a concomitant increase in Medicare case mix index (CMI), a surrogate marker of disease severity [15], going from an average of 1.02 during Fiscal Year 2015 to 1.29 through Fiscal Year 2018. The increase in inpatient volume is estimated to also have augmented hospital revenue by approximately $3 million dollars per year, P < 0.01 (Table 1).