A case study in APR-DRGs: the Greater Southeast Community Hospital experience

The need for accurate, valid, and reliable severity data has taken on increasing importance over the last several years. The impact of managed care has been particularly significant, with many conditions once treated on an inpatient basis now being managed in the outpatient setting or admitted to the hospital only after the condition has progressed to a more advanced stage. The results has been an increasingly sicker inpatient population. Both hospitals and managed care organizations need data that will measure the impact of case mix complexity and severity on outcomes. This case study reviews one health care system's experience in finding a severity system that would have the acceptance of its medical staff. The study also reviews the analytic methodology by which severity-adjusted data are used to improve utilization and quality.