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Biomedical subjects

R Averill

Publications and source records attributed to R Averill.

9 recordsLinked to original sources
PubMed1999

The prospective risk adjustment system.

The Episode Classification System is intended to perform two tasks. First, it will be a prospective capitation risk adjuster and predict future health care costs. It will do this by assigning each individual a single capitation risk adjustment category based on an analysis of the medical history and of health care services rendered during a specific period of time. Second, the Episode Classification System will create retrospective severity adjusted Episodes of illness or Episodes of Care. These latter Episodes will provide a framework for relating patient characteristics to the amount, type, and duration of services provided during the treatment of a specific disease. These Episodes will give users the ability to understand past costs and the risk of mortality. As such they will form the basis for provider profiling by allowing users to analyze a complete clinical episode.

Actuarial Analysis↗
PubMed1976

AUTOGRP: an interactive computer system for the analysis of health care data.

AUTOGRP is an interactive computer system designed to facilitate rapid analysis of complex medical information. AUTOGRP allows the clinical or administrative expertise of the user to be combined with sophisticated computer techniques to permit rapid information retrieval, hypothesis testing, development of norms, and identification of deviant cases. This interaction yields results of a uniquely high statistical and medical quality. AUTOGRP has been used to aid in understanding the process of patient care management in a variety of settings in order to enhance the effectiveness of decision-making from both a medical and management point of view.

Computers↗
PubMedDate not supplied

Payment and provider profiling of episodes of illness of clinical illnesses involving rehabilitation.

The prevailing trend in American health care finance for the last two decades and likely for the forseeable future, is the movement from a system based on fee for service payments to one dominated by capitation arragements. At the core of this change is a shifting of risk from payers to providers. Such a fundamental transition is not without its difficulties. This is exemplified by some of the problems experienced by the Health Care Financing Administration (HCFA) as it has begun to encourage beneficiaries to move from traditional fee for service Medicare to capitated HMOs. The most recently published regulations involving risk adjustment of rates of payment for managed care organizations (MCOs) did not find much favor as the statistical power was poor and the clinical meaningfulness of the risk adjustment was highly problematic. Specifically, the risk adjustment explained less than 10% of the variation in costs (compared to approximately 30% when DRGs were first implemented). From a clinical perspective, the methodology only used hospitalization data for adjustment of capitation rates; that is, anyone who was not hospitalized was assumed to be healthy! It is known that payment for rehabilitation services is among the most difficult to understand and predict of all medical care. This article will summarize the development of a new risk adjustment methodology which should be particularly useful for payment and monitoring of episodes of clinical conditions that involve rehabilitation. The article will conclude with directions for future research.

Capitation Fee↗