XIII. Hospital Information Systems: D. Case Mix and Resource Consumption Analysis from Medical Services Data: The Potential Side Effects of Case-Mix Reimbursement on Clinical Data Bases and Physician Behavior

摘要

Current pressures to utilize a case complexity or case-mix measure of hospital output for reimbursement purposes has two sources: a) the need to control hospital costs by relating amount of resource use to clinical conditions and b) the perceived inequity of ambulatory care reimbursement limitations. Although these pressures may be relieved by a case-mix hospital output measure, certain side effects may occur. The hospital clinical data base as reflected in the discharge abstract system will become more accurate although biased toward more costly case-mix categories. It will also be more complete, particularly with respect to surgical and other procedures. Physician behavior may change in three ways: a) actual diagnostic and therapeutic decision-making, b) the manner in which patient problems are represented in the information system, and c) admitting decision criteria.