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Developing a case-mix model for PPS.

H B Goldberg1, D Delargy

  • 1Abt Associates Inc, in Cambridge, Massachusetts, USA. henry_goldberg@abtassoc.com

Caring : National Association for Home Care Magazine
|May 2, 2000
PubMed
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Accurate case-mix adjustors are crucial for the success of prospective payment systems (PPS). This study details the development of a system to predict home health service needs based on patient characteristics.

Area of Science:

  • Health Services Research
  • Health Economics

Background:

  • Prospective Payment Systems (PPS) rely on accurate case-mix adjustors for success.
  • The Health Care Financing Administration (HCFA) sought a reliable method to predict home health service utilization.

Purpose of the Study:

  • To develop and validate a system for predicting home health service volume and type.
  • To ensure the system is feasible, clinically logical, valid, and accurate.

Main Methods:

  • Abt Associates Inc. was tasked with developing the predictive system.
  • The system focuses on patient characteristics to forecast service needs, not services received.

Main Results:

  • The abstract does not contain specific results, but outlines the approach to developing a predictive model.

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  • Focus on patient characteristics aims for a clinically logical and accurate prediction.

    • Conclusions:

    • The development of an accurate case-mix adjustor is critical for effective PPS implementation in home health.
    • The described approach by Abt Associates Inc. addresses key requirements for a valid and feasible system.