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Biomedical subjects

J D Chesney

Publications and source records attributed to J D Chesney.

13 recordsLinked to original sources
PubMed1993

The impact of diagnosis related group profitability on the skimming and dumping of psychiatric diagnosis related groups.

Psychiatric DRGs are identified in terms of their relative profitability within each hospital of a 386 hospital cohort. It is then determined whether hospitals admitted more of the more profitable and fewer of the less profitable patients over the period 1983-1987 (skimming). Also determined is whether hospitals discharged more of the less profitable to other short term hospitals over the same period of time (dumping). The findings generally indicate that this did not happen.

Cost-Benefit Analysis↗
PubMed1993

Profitable and unprofitable DRGs: the implications for access.

Given a choice, hospitals would prefer to admit a patient with the potential to contribute to an accounting profit and prefer not to admit a patient with the potential to contribute to an accounting loss. It is suggested that if all hospitals found the same DRGs to be unprofitable, access to inpatient care would be denied those patient types. A set of 509 hospitals was stratified according to bedsize, Medicare load, type of control, teaching status and geographic location. The 10 most and 10 least profitable DRGs were identified for each hospital category and a Spearman's rank order correlation was used to determine the similarity or dissimilarity across hospital category. The results indicate that the more alike hospitals are in terms of bedsize, Medicare load and teaching status, the more alike are the DRGs that are determined to be unprofitable (or profitable). Conversely, the less alike they were on these characteristics, the less alike were the unprofitable (or profitable) DRGs. There were no differences evident when the hospitals were classified according to type of control or geographic location. These results are generally encouraging in terms of potential access but disturbing in terms of possible further financial threat to rural hospitals.

Diagnosis-Related Groups↗
PubMed1991

The measurement of mortality. A risk-adjusted variable time window approach.

This paper describes the development of risk-adjusted mortality indices (RAMI) using 1985 MEDPAR data from 657 hospitals. The RAMI methodology is adopted from the Commission on Professional and Hospital Activities, however, both inhospital and post-discharge deaths are counted within time windows that vary by clinical condition. Five different RAMI measures (expected deaths/observed deaths) are developed, compared, and aggregated into various hospital characteristic strata. These measures vary by which discharge is held responsible for deaths within a time window, and whether or not inhospital deaths that occur beyond the time window are included. The RAMIs using varying time windows are compared with the RAMIs based upon inhospital deaths only. The inhospital RAMI was higher for the nonteaching hospitals (.95) as compared with the major and minor teaching institutions (.91 and .89). The RAMIs using the varying time windows, on the other hand, tend to be higher for the teaching institutions (e.g., 1.07 for major teaching hospitals; 0.99 for nonteaching hospitals).

Commission on Professional and Hospital Activities↗
PubMed1990

A reassessment of hospital product and productivity changes over time.

Were the changes found in the first year of the prospective payment system (PPS) one-time changes that attenuated as hospitals gained familiarity with the system? The results of this research show that, over time, discharges to home (self-care) continued to decrease, discharges to home health agencies continued to increase, but transfers and discharges to skilled nursing facilities or intermediate care facilities accounted for an increasing share of total discharges. After a dramatic decrease in the first year, the use of laboratory tests, diagnostic tests, and X-rays returned, over time, almost to pre-PPS levels.

Efficiency↗
PubMed1990

Utilization trends before and after PPS.

This article compares utilization trends for inpatient care before and after the introduction of Medicare's Prospective Payment System (PPS). Using discharges from a constant cohort of 419 hospitals over an eight-year period, I examine Medicare and non-Medicare utilization trends for the variables: total discharges, average length of stay (ALOS), average preoperative length of stay, average postoperative length of stay, percentage of patients using either ICU or CCU, and percentage of patients with consultations. Admission declines and the initial drop in ALOS are consistent with the initial program objectives and expectations. Post-PPS increases in ALOS, especially postoperative ALOS, are not consistent with PPS goals. Use of consultants and ICU/CCU facilities is not different before and after PPS.

Hospitals↗
PubMed1989

Were hospitals selective in their product and productivity changes? The top 50 DRGs after PPS.

Five separate hospital products are identified based on the concept of the amount of disease remission achieved by the hospital. The parameters of this concept are illness level on admission and discharge location. In a cohort of 646 nonfederal, short-term hospitals over the period 1980-1984, changes in the hospital product are examined separately in the 50 diagnosis-related groups (DRGs) with the greatest volume of Medicare discharges. Productivity changes, as defined by the number of certain inputs, are also examined. In both sets of analyses, patient severity level is controlled for by indexing to the base year (1980) case mix. The purpose of this study was to examine whether the dramatic product and productivity changes following implementation of the prospective payment system, as found in our earlier work, were across-the-board changes or the result of selective changes, specific to certain DRGs or products. The results suggest that the changes were an across-the-board phenomenon. Policy implications are discussed.

Adolescent↗
PubMed1988

Should DRG assignment be based on age?

The present Medicare Diagnosis Related Group (DRG) classification system contains 95 DRG pairs, where one DRG of the pair contains patients within a distinct diagnostic category who are under 70 years of age with no comorbidities or complications (CCs). The other DRG of the pair contains patients in the same diagnostic category who are over 69 or who have CCs. This study examines whether it is appropriate for reimbursement purposes to group those patients who are 70 years of age or older but have no CCs with patients who have CCs. Our findings show that age alone, in the absence of CCs, increases length of stay and cost of care only slightly. In fact, using only CCs as a classification variable reduces the within-group variance more than the present classification based on both age and CCs. Therefore, it is inappropriate to group Medicare patients who are older than 70 years of age without CCs with Medicare patients who have CCs.

Age Factors↗
PubMed1988

The Risk-Adjusted Mortality Index. A new measure of hospital performance.

The Commission on Professional and Hospital Activities (CPHA) developed the Risk-Adjusted Mortality Index (RAMI), a method for comparing hospital death rates using existing abstract or billing data. The method is comprehensive insofar as it includes all payers and all types of cases except neonates. RAMI was designed to differentiate among admissions on the basis of the patient characteristics that increase or reduce the risk of dying in the hospital. Using a large national data base, risk factors were determined empirically within each of 310 clusters based on diagnosis-related groups (DRGs). The model was very effective at predicting risk-adjusted outcomes, with a correlation of 0.98 between actual and predicted deaths in a sample of 300 hospitals. RAMI appears to be a powerful tool for using existing data to monitor changes over time in hospital death rates.

Adult↗
PubMed1987

The effect of PPS on hospital product and productivity.

The results suggest that Prospective Payment System (PPS) prompted a reduction in the proportion of Medicare patients that were discharged, for whom the hospital considered the episode of care to be completed. The results also show a reduction in the proportion of patients discharged dead. When controlling for patient type, the results support the findings, but the magnitude of the change that might be attributed to PPS is somewhat smaller. Proportional changes in the input measures for all patients were next considered. The results indicate that fewer diagnostic tests, fewer laboratory tests, and fewer x-rays were used in 1984. Laboratory tests showed the most dramatic decrease. LOS decreased, but the drug input remained fairly constant. A productivity index that reflects the change in the input measure while controlling for patient type was developed. The results provide strong evidence of a productivity increase in all products for Medicare patients. The drug input did not contribute to the productivity increase. The 50 most frequent DRGs for Medicare patients were examined separately for productivity changes by product. The results further support the findings of an increase in productivity.

Commission on Professional and Hospital Activities↗
PubMed1984

Citizen participation on regulatory boards.

This article examines the relationship between regulatory board function and citizen participation. The research indicates that public members generally prefer advisory boards, while provider members prefer quasi-judicial bodies. Implications of these findings for structuring citizen participation in the regulatory process are examined.

Community Participation↗
PubMed1983

Quantitative analysis of a licensing examination using adverse impact.

Does licensure restrict entry fairly, or does it serve as a discriminatory barrier for minorities? The use of the concept of adverse impact, a legally mandated, quantitative tool to assess selection procedures, is a useful mechanism to make such determinations. The results of a study in Michigan of the nursing examination for licensure show how adverse impact may be used. The implications of the outcome of the adverse impact study weigh heavily not only on the nursing examination but also on the use of such tools in other health professions.

Analysis of Variance↗
PubMed1982

Strategies for building representative HSAs: the impact of legal structure.

The goal of having local health planning agencies represent their communities is considered. A basic premise is that the legal structure of an agency is related to how well a community is represented. This premise is tested, and two strategies are presented for building HSAs which will include strong representation of traditionally under-represented or under-served groups: (1) increasing competition for governing-body membership by requiring all planning agency governing bodies to be small (30 members or less); and (2) increasing the organizational simplicity of the HSA.

Community Participation↗