Relate hospital charges to use of services

Despite their constantly rising charges that provoke government regulators and insurance companies to impose "caps," hospitals and other health care institutions continue to use antiquated cost control systems. This author describes a new accounting system, based on the amount of care each patient needs, that has been in use at Massachusetts Eye and Ear Infirmary for six years. In this system, basic "clinical care units" (determined by a peer review process and in collaboration with third-party payers) establish the acceptable standard for a given diagnosis. With charges and reimbursement based more directly on the labor and services involved, hospitals can plan more efficient use of nursing staff and other personnel and services. Use of established norms for each diagnosis also helps staff and third-party insurers determine when hospital resources are being used most productively.