Biomedical subjects
Publications and source records attributed to H D Doremus.
Health-care executives need to eliminate "gut feel" decisions with a standardized approach to business planning, such as Baxter Healthcare Corp.'s Healthcare Business Planner. The author illustrates how University Hospitals of Cleveland used this model to determine the feasibility of an ambulatory center dedicated to systemic lupus erythematosus.
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The organization of the enzymes of de novo pyrimidine nucleotide biosynthesis in pea (Pisum sativum L. cv Progress No. 9) has been studied. The first three enzymes of the pathway, carbamoyl-phosphate synthetase, aspartate carbamoyltransferase, and dihydroorotase, are readily separable from one another; they are not part of a multifunctional complex. The final two activities of the pathway, orotate phosphoribosyltransferase and orotidylate decarboxylase, copurify and appear to be complexed in vivo. This organizational pattern is distinct from those reported for bacteria, yeast, and mammals. The differences in organization, in a pathway which is present in all organisms, make the pyrimidine biosynthetic pathway a very interesting candidate for evolutionary studies.
During the past two decades, the health care industry has become an economic giant growing from 6.1% ($42.0 billion) of the gross national product in 1965 to an estimated 10.7% ($354.6 billion) in 1983. The industry is now the nation's third largest. The underlying causes of this remarkable growth include an open-ended reimbursement system, insatiable demand, and the lack of traditional market forces that encourage efficiency. Unfortunately, the nation cannot continue to allocate an increasing share of its gross national product to health care, for to do so would mean that other important sectors of the economy would experience either retarded growth or a decline in real terms. By the 2000, fundamental elements of the health care system will have undergone a major metamorphosis which hopefully will result in a more efficient and effective allocation of the health care dollar. This article will offer an overview of the changes likely to occur in sections of the health care environment of major concern to the health care planner.
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The Health Care Finance Administration has developed a Medicare reimbursement methodology that will include an adjustment factor for hospital case mix. The patient classification scheme proposed for use in determining a hospital's case mix is the AUTOGRP Diagnosis-Related Groups (DRG) methodology developed at Yale University. The reliability of a case mix measure calculated using the DRG methodology is dependent on complete and accurate diagnostic and surgical data. The source of this data for the HCFA data base (MEDPAR) is the Medicare billing form, which is based on the patient medical record. Data from the MEDPAR file, the original medical record discharge order, and a reabstracted record are compared and analyzed for their effect upon DRG classification and the resultant Medicare reimbursement ceiling for one large teaching hospital. The study results show widely divergent diagnostic and surgical data that results in a significant variation in DRG classification and reimbursement ceilings.
The development of diagnosis related groups has fed what may be unrealistic hopes for their wide application.