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Related Experiment Videos

Coding response to a case-mix measurement system based on multiple diagnoses.

Colin Preyra1

  • 1Department of Health Policy, Management and Evaluation, University of Toronto, Canada. Colin@preyra.com

Health Services Research
|July 3, 2004
PubMed
Summary

Hospitals increased reporting of complex cases after a new payment model, but this did not improve cost accuracy or reduce reliance on teaching adjustments. Coding changes impacted predicted hospital costs.

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Area of Science:

  • Health economics
  • Hospital management
  • Health services research

Background:

  • Payment models increasingly use case-mix measurement systems.
  • Refined systems incorporate multiple diagnoses to assess patient complexity.
  • Understanding hospital coding response is crucial for accurate cost modeling.

Purpose of the Study:

  • To examine hospital coding response to a payment model using a case-mix system.
  • To assess the impact of this response on a hospital cost model.

Main Methods:

  • Analysis of financial, clinical, and supplementary data from Ontario short stay hospitals (1997-2002).
  • Examination of case-mix trends after adopting an inpatient classification system using secondary diagnoses.
  • Decomposition of hospital case mix into base and complexity components.

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  • Assessment of coding variation effects on payment accuracy and adjustment factors.

    • Main Results:

    • Hospitals increased secondary diagnosis reporting, leading to more high-complexity cases.
    • This coding response was not matched by increased resource use.
    • Increased case-mix complexity did not reduce unexplained hospital unit cost variation.
    • Reliance on the teaching adjustment factor persisted.

    Conclusions:

    • Refined diagnostic related group (DRG)-type payment systems can induce changes in hospital coding practices.
    • Model performance assessment must include coding practice robustness.
    • Unanticipated coding effects can impact the ex ante performance of case-mix models.