1 / 81

Diagnosis Related Groups (DRGs)

Diagnosis Related Groups (DRGs). Diagnosis Related Group.

najila
Download Presentation

Diagnosis Related Groups (DRGs)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diagnosis Related Groups (DRGs)

  2. Diagnosis Related Group • DRG Diagnosis Related Group. A "Diagnosis Related Group" is a payment category that is used to classify patients, especially Medicare patients, for the purpose of reimbursing hospitals for each case in a given category with a fixed fee regardless of the actual costs incurred. A DRG is based upon the principal ICD-9-CM diagnosis code, ICD-9-CM surgical procedure code, age of patient, and expected length of stay in the hospital that will be reimbursed, independently of the charges that the hospital may have incurred

  3. DRG OVERVIEW: • The American health care system was quite different than it is today.  Back in the 1950s not everyone had health insurance, mostly those who did had either private insurance or BC/BS (Blue Cross/Blue Shield).  In the 1960s Medicare and Medicaid was created.  • In the 1970s, there was a lot of distrust for the U.S. government including lack of confidence in the American medical system.  There were many without insurance and a great number of companies did not offer health care benefits.  President Nixon created Managed Care Organizations (MCOs), which required companies to provide health insurance for their employees.  

  4. What really transformed is the way in which inpatient health care would be reimbursed in the 1980s.  Health care costs were out of control.  Facilities were being reimbursed for what services they provided regardless of cost (fee for service or time rendered) and there was no incentive for them to streamline costs.  Congress implemented the UB-82 (now UB-92) to create one claim form for all insurance agencies for inpatient services.   The DRG system was created in 1983 to cut costs for Medicare patients.  The DRG system is a patient classification system that groups patients with similar diagnoses and/or procedures into the same category.  The facility is then reimbursed with a lump sum payment based on this category, figuring on average what it would cost to treat a patient with a diagnosis.  Congress also required that facilities have an active Utilization Review and Quality Assurance Department to evaluate the quality of care patients are receiving and how that care is utilized (how much resources are used) to care for the patient.

  5. History • In the mid 1970s the Centre for Health Studies at Yale University began work on a system for monitoring hospital utilisation review. Following a 1976 trial of a DRG system, it was decided to base the final system on the ICD-9-CM which would provide the basic diagnostic categories

  6. Purpose. • relate a patient’s diagnosis and treatment to the cost of their care • Developed in the United States by the Health Care Finance Administration • DRGs are used for reimbursement in the prospective payment system of US Medicare and Medicaid healthcare insurance systems • DRGs were designed to support the calculation of federal reimbursement for healthcare delivered through the U.S. Medicare system

  7. A patient’s principal diagnoses and the procedures they are treated with during hospital admission are used to select the group in the DRG classification that most appropriately describes they overall type of care that has been delivered. • Diagnosis Related Groups (DRG) are a system classifying in-hospital patient cases into categories with similar resource use. The grouping is based on diagnoses, procedures performed, age, sex and status at discharge • Next the group selected is associated with a typical cost. Specifically, DRG funding requires the use of a cost weighting that is applied by the funding agency to determine the actual amount that should be paid to an institution for treating a patient with a particular DRG. The weightings are determined by a formula that is typically developed on a state or national basis.

  8. DRG Structure • Major Diagnostic category • Medical Surgical split • Complications & Comorbidities • Exclusion list • Structure diagram • DRG Example with severity score

  9. Major Diagnostic Category Assignment (MDC) • The initial step in the determination of the DRG has always been the assignment to the appropriate MDC based on the Principal Diagnosis • Since the presence of a surgical procedure requires different hospital resources (operating room, recovery room, anesthesia) most MDCs were initially divided into medical and surgical groups

  10. Medical Surgical split • All procedure codes were classified based on whether or not they required the use of an operating room • Operating room procedures • – Cholecystectomies– Cerebral meninges biopsies– Closed heart valvotomies • Non operating room procedures • – Bronchoscopy– Skin sutures

  11. Complications & Comorbidities (CCs) • A complication is a condition which did not exist prior to the admission • A comorbidity is a condition which existed prior to admission • A complication or comorbidity is a secondary diagnosis which would be expected to extend the patient’s length of stay by at least one day in at least 75 percent of patients

  12. Major CCs • Within each MDC patients with major CCs (e.g., AMI, CVA, etc.) were assigned to separate DRGs, and as part of the Severity Level process of IR-DRGs • A major complication or comorbidity is a secondary diagnosis which would be expected to extend the patient’s length of stay by at least 3-4 days in at least 75 percent of patients

  13. Complication & Comorbidity(CC) Exclusion List • For a principal diagnosis of bladder neck obstruction • – Urinary retention is not a CC • For a principal diagnosis of general convulsive epilepsy • – Convulsion is not a CC

  14. DRG Classification - Example • Principal Diagnosis 41091: AMI NOS, Initial MDC 5 Diseases and Disorders of the Circulatory System • Operating Room Procedure 3761:Pulsation Balloon Implant • DRG 110: Major Cardiovascular Procedures with CC orDRG 111: Major Cardiovascular Procedures without CC orDRG 549: Major Cardiovascular Procedures with Major CC • Secondary Diagnosis • 1) 25000: Diabetes Mellitus Type II without Complications • - CC : No • - Major CC : No • - DRG : 111

  15. DRG Classification - Example 2 • Principal Diagnosis 41091: AMI NOS, Initial • MDC 5 Diseases and Disorders of the Circulatory System • Operating Room Procedure 3761:Pulsation Balloon Implant • DRG 110: Major Cardiovascular Procedures with CC orDRG 111: Major Cardiovascular Procedures without CC orDRG 549: Major Cardiovascular Procedures with Major CC • Secondary Diagnosis1) V434: Blood Vessel Replacement Not Elsewhere Classified (NEC) • - CC : No • - Major CC : No • 2) 7100: Systemic Lupus Erythematosus • - CC : Yes • - Major CC : No • - DRG: 110

  16. DRG Classification - Example 3 • Principal Diagnosis 41091: AMI NOS, Initial • MDC 5 Diseases and Disorders of the Circulatory System • Operating Room Procedure 3761:Pulsation Balloon Implant • DRG 110: Major Cardiovascular Procedures with CC orDRG 111: Major Cardiovascular Procedures without CC orDRG 549: Major Cardiovascular Procedures with Major CC • Secondary Diagnosis • 1) 78551: Cardiogenic Shock • - CC : No • - Major CC : Yes • - DRG : 549

  17. Surgical Hierarchy • If multiple procedures are present, the patient is assigned to a single surgical DRG based on a surgical hierarchy within each MDC

  18. DRG Structure • ساختار كلي DRG از 3 جزء تشكيل شده كه عبارتند از: • PreMDC كه همان قسمت استثناء DRG است • MDC كه همان قسمت اصلي است • ErrorDRG كه از نظر اطلاعات بهداشتي ناقص است. به عبارت ديگر يا اطلاعات موجود در پرونده متناقض يا غير معتبر است و يا تشخيص گزارش شده دقيق و كامل نيست و نمي توان كد DRG خاصي به آن اختصاص داد. اين كدها عبارتند از: • كد 468: اگر بيماري به علتي در بيمارستان بستري شود و به علت ديگري مورد عمل جراحي قرار گيرد،كد DRG468 به آن اختصاص مي يابد.مثلا بيماري كه با تشخيص اصلي نارسايي احتقاني قلب بستري شده اما بدليل التهاب كيسه صفراي رو به پيشرفت ، اقدام جراحي خارج ساختن كيسه صفرا براي وي انجام شده است. • باشد با كد DRG 470 مشخص مي شود.

  19. DRG Structure • كد 469: زماني كه تشخيص اصلي انتخاب شده به اندازه كافي دقيق و درست نيست تا بتوان كد خاصي از DRG را به بيمار اختصاص داد از اين كد استفاده مي شود. حتي اگر كدي از ICD براي آن مورد در نظر گرفته شود. مثلا كد 646.90 در ICD-9-CM نشان دهندة عوارض نامشخص پيش از زايمان، هنگام زايمان و پس از زايمان است. در DRG بايد اطلاعات نشان دهد در كدام مرحله از مراقبت عارضه ايجاد شده است و در صورتي كه مشخص نباشد، كد DRG 469 به آن اختصاص مي يابد. • كد 470: اشتباهات ثبت شده در گزارش هاي پزشكي كه ممكن است بر تخصيص كد DRG اثر بگذارد با اين كد مشخص مي شود. مثلا بيماري كه در گزارشات سن وي 154 سال گزارش شده، در صورتي كه انتخاب كد با سن بيمار بستگي داشته

  20. DRG assignment • The first step in DRG assignment is the classification of discharges by Major Diagnostic Category (MDC). There are 25 MDCs which are essentially primary diagnostic groupings generally based on the body systems, e.g. nervous system (MDC 1), eye (MDC 2), circulatory system (MDC 5), etc.There are some exceptions where the classification by MDC does not follow this pattern, for example MDC 14: Pregnancy, Childbirth, and the Puerperium, MDC 24: Multiple Trauma, and MDC25: HIV Infection. • Following assignment to the MDC, discharges are assigned to the DRG level. Discharges with a surgical procedure performed are assigned to the surgical DRGs where classification is based on the most resource intensive procedure

  21. performed. Medical discharges are assigned to a DRG on the basis of the principal diagnosis. Further classification within these groups arise if particular variables, like the presence of complications/comorbidities (ccs), age, or discharge status are found to have a significant influence on the treatment process and/or the pattern of resource utilisation. Some exceptions to the general approach for DRG classification do exist, for example, discharges receiving liver or bone marrow transplants and discharges with temporary tracheostomies being assigned to DRGs outside of the MDC framework

  22. DRG assignment • A DRG is assigned based on the patient's diagnosis (ICD-9-CM coding).  The encoder (also known as the DRG grouper) is a software program developed by CMS that places the patient into a Major Diagnostic Category based on the diagnosis.   • For example:  A patient with a fracture  would be grouped to the Musculoskeletal Major Diagnostic Category.  At this point, the patient is considered a medical DRG.  If the patient has a surgical procedure, then the patient is grouped to a surgical DRG.  The other factors that influence DRG assignment is age of the patient, any complication/comorbidities, and discharge status.

  23. Illustration of DRG-grouping, patient > 17 years Major diagnosis ICD10 S72.0:Fracture of the collum femoris MDC 08: Rheumatic diseases Surgical procedures No Yes Type of surgery Amputation NCSP 50 Marrow nailing Biopsy Secondary diagnosis Yes DRG 236: Hip/pelvis fracture DRG 213: Amputations DRG 211: Hip/thigh bone operation DRG 210: Hip/thigh bone operation DRG 216: Biopsies (rheumatic diseases)

  24. DRG assignment • كدهاي ICD بر اساس سيستم هاي بدن يا تخصص در گروه هاي تشخيصي اصلي [1] قرار مي گيرند. • افرادي كه پس از عمل جراحي مرخص شده اند در گروه جراحي و كساني كه عمل جراحي نداشته اند در گروه پزشكي قرار مي گيرند. • كساني كه در گروه جراحي قرار مي گيرند بر اساس ميزان مصرف منابع به چند گروه تقسيم مي شوند. بيماراني كه چند عمل جراحي داشته اند، بر اساس پرهزينه ترين جراحي طبقه بندي مي شوند. مثلا اگر اقدام كورتاژ و ديلاتاسيون[2] و خارج كردن رحم[3] بطور همزمان بر روي بيمار انجام شود، چون ذرآوردن رحم نياز به تدابير بيشتري دارد، به عنوان اقدام پر هزينه تر انتخاب مي شود.

  25. DRG assignment • كساني كه در گروه پزشكي قرار گرفته اند بر اساس تشخيص اصلي به گروه هاي فرعي مانند نئوپلاسم و... تقسيم مي شوند. • در اين گروه ها بيماراني كه به روش هاي مشابه و توسط متخصصين مشابه درمان مي شوند، در يك گروه DRG قرار مي گيرند. • براي گروه بندي نهايي از تشخيص اصلي، عوارض ، بيماري هاي همراه ، سن بيمار، جنس بيمار و وضعيت هنگام ترخيص (مرده، زنده، پيگيري بعدي) استفاده مي كنند. • [1] Major Diagnostic Category (MDC) • [2] Dilatation & Curettage (D&C) • [3] Hysterectomy

  26. Example • بيماري با تشخيص ديابت (شروع در بزرگسالي ) و كوليك حاد شكمي پذيرش شده است. پيگيري هاي بعدي سنگ كيسه صفرا را نشان داده است. براي بيمار خارج كردن كيسه صفرا و جستجوي مجاري صفراوي انجام شده است. ديابت بيمار اغلب مدت زماني كه بيمار در بيمارستان اقامت داشته است خارج از كنترل بوده است. • سيستم بدني درگير، سيستم كبدي- صفراوي و پانكراس بوده است. چون برروي بيمار عمل جراحي انجام شده است، اقدام جراحي محسوب مي شود و هيچگونه عوارض يا بيماري همزمان نداشته است.

  27. DRG information for DRG-production and DRG-reimbursement

  28. Payment calculation • پس از مرخص شدن بيمار، پزشك تمامي تشخيص ها و درمان ها را روي فرم مخصوص ثبت مي كند. • سپس كد مناسب ICD-9-CM توسط كدگذار تعيين و ثبت مي شود. • بخش حسابداري بيمارستان فرم صورتحساب را فراهم مي كند كه درآن فرم اطلاعات هويتي بيمار، كدهاي ICD-9-CM و ساير اطلاعات ثبت مي شود. • در مرحله بعد كارگزاران مالي صورتحساب يا ليست مورد نظر را ازجهت خوانا بودن و تناسب كدها و صحيح بودن آنها بررسي مي كنند و بر اساس كدهاي ICD-9-CM كد DRG تعيين مي شود. • هر گروه DRG يك ارزش نسبي دارد كه هزينه كليه خدمات و تجهيزات مصرف شده براي بيمار را منعكس مي كند. هرچه اين ارزش بيشتر باشد منابع بيشتري مصرف شده و هزينه بيمار افزايش مي يابد. ارزش نسبي هر گروه DRG در بيمارستان هاي مشابه يكسان است. • [1] Hospital rate

  29. Payment calculation • مقدار پرداخت هزينه بيمارستاني در هر بيمارستان بر اساس عوامل مختلف نظير نوع بيمارستان، جغرافيايي، روستايي يا شهري بودن بيمارستان، اختلاف نرخ دستمزد در نواحي مختلف و ساير عواملي كه بر هزينه تاثير دارند تعيين مي شود ، اين مقدار نرخ بيمارستاني [1] نام دارد كه ممكن است در سالهاي مختلف بر اساس نرخ تورم تغيير كند. قبلا وضعيت آموزشي و تعداد تخت نيز در محاسبه هزينه ها بحساب مي آمد ، ولي امروزه تاثير اين عوامل رد شده است. • لذا هزينه بيماران از حاصلضرب نرخ بيمارستاني در هزينه ثابت بدست مي آيد. به اين ترتيب بيمارستان مبلغ ثابتي را دريافت مي كند ، درصورتي كه هزينه بيمار كمتر از هزينه دريافتي باشد، بيمارستان مي تواند مابه التفاوت را بعنوان سود ذخيره نمايد و بر عكس چنانچه هزينه صرف شده براي بيمار بيشتر از مبلغ DRG باشد، بيمارستان مجبور است خسارات وارده را متحمل شود. اين امر باعث مي شود بيمارستان ها ، بيماران سودمند را انتخاب كنند و از درمان بيماران زيان آور خودداري كنند.

  30. CODING AND ITS RELATION TO DRG ASSIGNMENT • Coding is a team approach.  If there is improper documentation the facility, along with the physician, are considered noncompliant in reflecting the patient's true hospital course.  Coding can only be done in an accurate, timely, and ethical manner by using conclusive documentation by physicians.   • It is the role of the coder to go through the whole medical record to locate all the information to accurately code including ethically coding complications and comorbidities.  These conditions can be found in various placed in the medical record.  The medical record needs to be comprehensive, legible, well-documented, and completed in a timely fashion to be compliant.  Lacking any of these will place the facility in danger of being audited, increasing the risk of fraud and abuse.

  31. Inpatient Classification Objectives • Aid in Clinical Management • Provide Equitable Resource Allocation Method • Promote Efficiency & Effectiveness in Managing Inpatient Care • Increase Accuracy in Reporting Workload and Associated Costs

  32. Develop a classification system that is the basis for • Hospital Management • Budgeting • Benchmarking • Profiling • Clinical research • Quality reporting • Global comparison • Payment

  33. Level of acceptance and use • DRGs are used routinely in the United States for management review and payment for Medicare and Medicaid patients. Given the importance of reimbursement world-wide, DRGs have undergone ongoing development, and have been adopted in one form or another in many countries outside the USA, including Australia (AR-DRG), Canada (CMG) and countries of Europe and Asia.

  34. Classification structure • Patients are initially assigned a code from ICD-9 CM or a clinical modification of ICD-10. ICD clinical modifications are multiaxial systems closely based on the ICD structure. Diagnoses are then partitioned into one of about 25 Major Diagnostic Categories (MDCs) according to body organ system or disease. The aim of this step is to group codes into similar categories that reflect consumption of resources and treatment .The categories are next partitioned based upon the performance of procedures, and on other variables such as the presence of complications and co-morbidities, patient age, and length of stay, before a DRG is finally assigned .There is thus a process of category reduction at each stage, starting from the many thousands of ICD codes to the few hundred DRGs: • ICD  MDC  DRG)

  35. DRGs and case-mix indices will always only give approximate estimates of the true resource utilisation. For example, should a hospital that is developing new and expensive procedures be paid the same amount as an institution that treats the same type of patient with a more common and cheaper procedure? Should quality of care be reflected in a DRG? For example, if a hospital delivers good quality of care that results in better patient outcomes, should it be paid the same as a hospital that performs more poorly for the same type of patient? As importantly, those institutions that are best able to create DRGs accurately are more likely to receive reimbursement in line with their true expenditure on care. There is thus an implication in the DRG model that an institution actually has the ability to accurately assemble information to derive DRGs and a case-mix index. Given local and national variations in information systems and coding practice, it is likely that institutions with poor information systems will be disadvantaged. Limitations

  36. Developments • DRGs are designed for use with inpatients. Accordingly, other systems have been developed for other areas of healthcare. Systems such as Ambulatory Visit Groups (AVGs) and Ambulatory Payment Classifications (APCs) have been developed for outpatient or ambulatory care in the primary sector. These are based upon a patient’s diagnosis, intervention, visit status and physician time.

  37. The DRG Handbook, 2003

  38. DRG audits DRG audits may consists of evaluating those DRGs that are incorrectly used.  These audits may also focus on missing diagnoses, missing procedures, and incorrect principal diagnosis selection For DRG based reviews, cases may be selected in a variety of ways: • • Simple random sample • • High dollar and high volume DRGs • • DRGs without comorbid conditions or complications • • Focused DRGs such as DRG 79 Pneumonia or DRG 416 Septicemia and other high • risk DRGs • • Correct designation of patient discharge and transfer status

  39. CPT audits For physician services, hospital outpatient services, and freestanding ambulatory surgery centers, audits may focus on the following: • • Evaluation and management services for physician visits • • High volume and/or low volume outpatient surgeries • • Use of CPT modifiers on physician and outpatient claims • • Unlisted CPT codes • • Diagnosis codes on outpatient claims for medical necessity of diagnostic services • • Accurate use of ICD-9-CM and CPT for ambulatory surgery services

  40. Ten DRGs with the highest rates of upcoding • In its August 1998 report, Using Software to Detect Upcoding of Hospital Bills, the Office of Inspector General lists the following diagnosis-related groups as having the highest rates of upcoding. • 87-pulmonary edema and respiratory failure • 79-respiratory infections and inflammations with complicating conditions (cc) • 144-other circulatory system diagnoses with cc • 239-pathological fractures and musculoskeletal and connective tissue malignancy • 429-organic disturbances and mental retardation • 416-septicemia • 475-respiratory system diagnosis with ventilator support • 188-other digestive system diagnoses with cc • 121-circulatory disorders with acute myocardial infarction and cardiovascular complications, discharged alive • 316-renal failure

  41. case-mix • DRGs are also used to determine an institution’s overall case-mix. The case-mix index helps to take account of the types of patient an individual institution sees, and estimates their severity of illness. Thus a hospital seeing the same proportion of patients as another, but dealing with more severe illness, will have a higher case-mix index • An institution’s case-mix index can then be used in the formula that determines reimbursement per individual DRG

  42. Case mix calculation • بيماران مراجعه كننده به بيمارستان در يك دوره زماني خاص ( مثلا يكسال) را در نظر مي گيريم و مشخص مي كنيم هر بيمار در چه گروه DRG قرار گرفته است. سپس تعداد بيماران هر گروه DRG را در ارزش نسبي همان گروه ضرب مي كنيم.سپس اين مقادير را با يكديگر جمع كرده و بر تعداد كل بيماران در آن دوره خاص تقسيم مي كنيم. هر قدر عدد بدست آمده بزرگتر باشد، هزينه تمام شده براي هر بيمار بيشتر بوده و بعبارت ديگر بيمارستان خدمات ارزنده تري را ارائه داده است. • مثال: در يك دوره زماني خاص ، 1000 بيمار به بيمارستاني مراجعه كرده اند. 200 بيمار كد 450 ، DRG 90 بيمار كد 89، 50 بيمار كد 410 و 300 بيمار كد 475 را به خود اختصاص داده اند. ارزش نسبي اين كدها به ترتيب 6990/.، 1447/1، 134/5، 9363/. مي باشد. كيس ميكس اينگونه محاسبه مي شود: Case mix = (200×6990/.)+(450×1447/1)+(300×134/5)+(50×9363/.) 1000 Case mix =2/24

  43. Example • دو بيمارستان با شرايط زير را مقايسه كنيد. • هر دو 200 بيمار را پذيرش كرده اند. • در هر دو بيمارستان ، تعداد روزبيمار 1200 روز بوده است. • متوسط اقامت بيماران حدود 6 روز بوده است. • ظاهرا راندمان دو بيمارستان يكسان است. اما با بررسي دقيق تر مشخص مي شود در بيمارستان الف نيمي از بيماران با تشخيص فتق كشاله ران با ارزش نسبي 0.5 و نيم ديگر با تشخيص زخم معده پيچيده با ارزش نسبي 1.0 بستري شده اند بنابر اين كيس ميكس چنين محاسبه مي شود: • Case mix = (100×./5+(100×1) = 150 • در بيمارستان ب 100 بيمار با تشخيص جراحي باي پس با ارزش نسبي 5.5 وبراي 100 بيمار ديگر پيوند كليه با ارزش نسبي 3.84 انجام شده است. بنابر اين كيس ميكس چنين محاسبه مي شود: • Case mix = (100×5/5+100×3/84)= 934 • به اين ترتيب مقايسه كيس ميكس ها نشان مي دهد بيمارستان ب تقريبا 9 برابر بيمارستان الف از منابع مصرف كرده است.

  44. OPTIMIZATION AND CASE MIX • Optimization may not be gained if the coder is inexperienced in reading the medical record, understanding disease processes, unable to understand where to look for additional information such as drug usage, tests ordered, etc.  By providing the coder with ongoing education, this increases the chance that increased optimization.  Optimization may also not be possible due to lack or poor documentation and poor team relationships.    • Case mix is defined as the type of patients the hospital treats.  Facilities are very concerned on whether their patients are making them money or do they have a high percentage of patients in which it costs the facility more to treat the patient then what they are being reimbursed for. 

  45. Case-Mix System is very appropriate especially in justifying the usage of optimum resources in tertiary care hospitals which admits more severe cases. At present, the allocation of resources to hospitals are among others based on the number of beds and previous resource utilization without considering efficiency and thus did not contribute to the improvement of hospital efficiency. Case-Mix System also facilitates in the implementation of quality enhancement programm in line with it original objective of classification. Information on patients’ treatment such as length of stay helps in identifying differences in treatment and problems in quality of patient care so it can be highlighted and managed immediately. Hospitals are also encouraged to

  46. standardize the treatment process using clinical guidelines and critical pathways in accordance to best practices to ensure that patients receive the best and most effective treatment. The Government of Malaysia has decided to introduce a national health care financing system to support the increasing health care cost and to enhance equity, accessibility, quality and efficiency in the health system. One of the element in financing is the health care provider payment mechanism based on this case-mix system. Therefore, HUKM has taken the initiative to lead the way in using case-mix system in this country and hope to extend its experience to other hospitals and insinuate its implementation to strengthen the health service in the country.

  47. What Case Mix Is • Refers to the Mix of Cases of a Hospital, the Range and Type of Patients Treated • Case Mix Information can tell us How Much Money Hospitals Need According to the Patients they Actually Treat • Case Mix is Hospital Final Output, Classified into Predetermined Categories (DRGs) • Case Mix Information about Resource Use and Quality can be Used as Standards for Hospitals to Compare Based on patient characteristics • Case Mix is a Tool - Case Mix Information Provides the Knowledge to Critically Examine Patient Care and Manage Appropriately Comparative data

More Related