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Refining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III)
B E Fries1, D P Schneider, W J Foley
1Institute of Gerontology, University of Michigan, Ann Arbor 48109-2007.
Medical Care
|July 1, 1994
Summary
A new Resource Utilization Groups (RUG-III) system classifies nursing home residents, improving cost prediction and care assessment. This system enhances accuracy for high-tech care and cognitive needs, aiding payment and management.
Area of Science:
- Gerontology
- Health Services Research
- Nursing Home Administration
Background:
- Accurate case-mix classification is crucial for fair nursing home reimbursement.
- Previous systems had limitations in explaining cost variations and identifying complex resident needs.
Purpose of the Study:
- To develop and validate the Resource Utilization Groups, Version III (RUG-III) case-mix classification system.
- To improve the explanation of cost variance and clinical validity compared to prior versions.
Main Methods:
- Utilized data from 7,658 nursing home residents across seven states.
- Assessed resident characteristics using Minimum Data Set items.
- Measured nursing and therapy staff time to determine resource utilization.
Main Results:
- The RUG-III system, with 44 groups, explained 55.5% of per diem cost variance.
- Identified high-tech procedures and cognitive impairments more effectively.
- Demonstrated a nine-fold range in mean resource use across case-mix groups.
Conclusions:
- RUG-III offers improved clinical validity and payment incentives for nursing homes.
- The system is suitable for payment, management, staffing, and quality assurance.
- Implementation is underway in multiple states, including federal demonstrations.