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Biomedical subjects

R M Coffey

Publications and source records attributed to R M Coffey.

13 recordsLinked to original sources
PubMed2001

Studying the effects of health plan competition: are available data resources up to the task?

OBJECTIVES: To review the availability of data sources to study health plan competition in the United States. DATA SOURCES: The literature on health plan competition was reviewed. Possible data sources to study health plan competition were evaluated. Experts in the field of health plan competition were contacted about their knowledge of existing data sources. Principal Findings. There is much more quantitative data available on HMO plans than on other types of health plans that are growing in popularity, such as PPOs. A key source for health plan data, state health insurance filings, lacks information on beneficiaries in non-HMO plans. Data on health plan quality is growing. In addition, case studies of particular markets is providing useful qualitative information on the dynamics of the health plan industry. CONCLUSIONS: The fragmentation of the health care market and the hesitancy of governments and private organizations to provide detailed information across markets and providers creates serious obstacles to the study of health plan competition.

Databases, Factual↗
PubMed2000

Recent trends in the financing of substance abuse treatment: implications for the future.

OBJECTIVE: This article focuses on the implications of a recent study of substance abuse (SA) and mental health treatment expenditures for substance abuse treatment policy. Public and private expenditures for SA treatment are estimated and compared with those for mental health and all health care in the period between 1987 and 1997. METHODS/DATA SOURCES: Estimates of SA treatment expenditures were segregated from the Health Care Financing Administration's National Health Accounts across the ten-year period. Information about use, charges, and payments by provider type, payer, and diagnosis was obtained from numerous nationally representative data sets and large claims databases. Those data were used to estimate SA treatment expenditures in the general service sector. For the specialty sector two specialty facility surveys were used to estimate SA treatment expenditures. Information from the two sectors was combined and reconciled to the National Health Accounts. PRINCIPAL FINDINGS. A dramatic shift in SA expenditures away from private financing and toward public payers, as well as a shift away from hospital treatment settings, occurred between 1987 and 1997. CONCLUSIONS: Evidence from this article and other research suggests that growth in SA expenditures has been contained relative to growth in all health spending. How savings from SA treatment are being invested and whether expenditure levels are appropriate to supply treatment of acceptable quality needs further study.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

Comorbidity measures for use with administrative data.

OBJECTIVES: This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets. METHODS: The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other aspects of the patient's condition, development of a comorbidity algorithm, and testing on heterogeneous and homogeneous patient groups. Data were drawn from all adult, nonmaternal inpatients from 438 acute care hospitals in California in 1992 (n = 1,779,167). Outcome measures were those commonly available in administrative data: length of stay, hospital charges, and in-hospital death. RESULTS: A comprehensive set of 30 comorbidity measures was developed. The comorbidities were associated with substantial increases in length of stay, hospital charges, and mortality both for heterogeneous and homogeneous disease groups. Several comorbidities are described that are important predictors of outcomes, yet commonly are not measured. These include mental disorders, drug and alcohol abuse, obesity, coagulopathy, weight loss, and fluid and electrolyte disorders. CONCLUSIONS: The comorbidities had independent effects on outcomes and probably should not be simplified as an index because they affect outcomes differently among different patient groups. The present method addresses some of the limitations of previous measures. It is based on a comprehensive approach to identifying comorbidities and separates them from the primary reason for hospitalization, resulting in an expanded set of comorbidities that easily is applied without further refinement to administrative data for a wide range of diseases.

Adult↗
PubMed1996

Trauma systems and the costs of trauma care.

OBJECTIVE: This study examines the cost of providing trauma services in trauma centers organized by publicly administered trauma systems, compared to hospitals not part of a formal trauma system. DATA SOURCES AND STUDY SETTING: Secondary administrative discharge abstracts for a national sample of severely injured trauma patients in 44 trauma centers and 60 matched control hospitals for the year 1987 were used. STUDY DESIGN: Retrospective univariate and multivariate analyses were conducted to examine the impact of formal trauma systems and trauma center designation on the costs of treating trauma patients. Key dependent variables included length of stay, charge per day per patient, and charge per hospital stay. Key impact variables were type of trauma system and level of trauma designation. Control variables included patient, hospital, and community characteristics. DATA COLLECTION/EXTRACTION METHODS: Data were selected for hospitals based on (1) a large national hospital discharge database, the Hospital Cost and Utilization Project, 1980-1987 (HCUP-2) and (2) a special survey of trauma systems and trauma designation undertaken by the Hospital Research and Educational Trust of the American Hospital Association. PRINCIPAL FINDINGS: The results show that publicly designated Level I trauma centers, which are the focal point of most trauma systems, have the highest charge per case, the highest average charge per day, and similar or longer average lengths of stay than other hospitals. These findings persist after controlling for patient injury and health status, and for demographic characteristics and hospital and community characteristics. CONCLUSIONS: Prior research shows that severely injured trauma patients have greater chances of survival when treated in specialized trauma centers. However, findings here should be of concern to the many states developing trauma systems since the high costs of Level I centers support limiting the number of centers designated at this level and/or reconsidering the requirements placed on these centers.

Adolescent↗
PubMed1995

Treating early-stage breast cancer: hospital characteristics associated with breast-conserving surgery.

Despite growing acceptance of the fact that women with early-stage breast cancer have similar outcomes with lumpectomy plus radiation as with mastectomy, many studies have revealed the uneven adoption of such breast-conserving surgery. Discharge data from the Hospital Cost and Utilization Project, representing multiple payers, locations, and hospital types, demonstrate increasing trends in breast-conserving surgery as a proportion of breast cancer surgeries from 1981 to 1987. Women with axillary node involvement were less likely to have a lumpectomy, even though consensus recommendations do not preclude this form of treatment when local metastases are present. Non-White race, urban hospital location, and hospital teaching were associated with an increased likelihood of having breast-conserving surgery.

Aged↗
PubMed1992

Change in the Medicare case-mix index in the 1980s and the effect of the prospective payment system.

Persistent increases in the Medicare case-mix index over the 1980s have been ascribed to changes both in medical treatment ("real changes") and in the way medical information is recorded ("coding changes") in hospitals. These changes have been attributed, in the absence of appropriate data and analyses, to the incentives of the Medicare prospective payment system (PPS). Using data for 1980-1986 from 235 hospitals, we estimate the effect on the Medicare case-mix index of a series of variables that reflect medical treatments and coding practices. Each of these underlying real or coding variables was changing prior to PPS and would likely have continued to change even in the absence of PPS. Furthermore, PPS may have had a distinct effect on these variables. These underlying trends and the PPS effects must each be estimated. Thus, the analysis begins by developing separate estimates for each of these real and coding variables (1) in the absence of PPS (autonomous effects) and (2) as a result of PPS (induced effects). Then, changes in the case-mix index are regressed against all of these variables to determine the degree to which specific autonomous real or coding variables or induced real or coding variables actually influenced measured case mix. Results show that real and coding changes each accounted for about half of the change in the Medicare case-mix index between 1980 and 1986, with the influence of coding starting to wane by 1986. PPS-induced factors explain about 80 percent of the change in measured case mix over time, autonomous factors about 20 percent. Especially powerful determinants of case-mix change included PPS-induced substitution of surgical for medical care and PPS-induced improvements in the accuracy of coding that led to assignment of patients to higher-weighted DRGs. Also, stringent Medicare peer review organizations appeared to restrain rises in case-mix indexes for their hospitals. Outpatient substitution for inpatient treatment, which others attributed to PPS, was well underway before PPS was announced.

Abstracting and Indexing↗
PubMed1987

Case-mix differences between teaching and nonteaching hospitals.

It has been suggested that teaching hospitals as a group have done well financially under Medicare's prospective payment system. If so, is this because teaching hospitals have reduced inefficiencies or because their case mix is not as severe as presumed? In this study, we used Disease Staging and diagnosis related groups (DRGs) to isolate case mix attributed to given patient populations from that attributed to hospital treatment standards. We also analyzed differences among types of teaching hospitals. We found few case-mix differences between teaching and nonteaching hospitals when the weighting system was independent of resource consumption (i.e., Disease Staging). However, when resources were used to weight case-mix measurement (i.e., DRGs), teaching hospitals were found to have a more serious case mix. We conclude that although teaching hospitals typically do not have a more severe case mix than nonteaching hospitals, they do use more resources to treat their patient mix under DRGs.

Diagnosis-Related Groups↗
PubMed1986

DRGs and disease staging for reimbursing Medicare patients.

Beginning October 1, 1983, Medicare began reimbursing many hospitals on the basis of a set of fixed fees tied to Diagnosis-Related Groups (DRGs). Using 1979-1981 Maryland data for Medicare patients, this paper compares the DRG system with the Disease Staging patient classification system in terms of structure, explanation of resource consumption (length of stay) of hospital patients, and impact on reimbursement by type of hospital. The two systems are conceptually and empirically different in classifying patients. Further, Disease Staging and DRGs perform similarly in explaining length-of-stay variation among Maryland patients. However, the two systems generate substantially different reimbursements by type of hospital. Surprisingly, large hospitals (including urban, not-for-profit, teaching hospitals) fare better under a DRG-based reimbursement system than under Disease Staging, a severity-of-illness system that excludes procedures as a basis of classification. These results imply that reimbursement policy based on Disease Staging would create disincentives to perform surgery compared with the current DRGs.

Diagnosis-Related Groups↗
PubMed1985

Hospital DRGs and the need for long-term care services: an empirical analysis.

The Medicare DRG-based Prospective Payment System (PPS) encourages hospitals to reduce length of stay for elderly patients. Thus, discharges to long-term care services are expected to increase. Maryland hospital data for 1980 are used to identify those DRGs which most frequently represent patients discharged to nursing home and home health care services; explores the incentive to discharge earlier under PPS those patients needing long-term care versus short-term care; and describes characteristics of patients most likely to face increased pressure of earlier discharge to nursing homes and home health programs. Because only a limited set of patient characteristics are available from Maryland hospitals, data from a study of San Diego nursing homes are used to explore further the sociodemographic and health status measures associated with unusually long stays in a hospital prior to nursing home placement. This research suggests that the DRG reimbursement system gives hospitals a strong incentive for earlier discharge of patients needing long-term care services. However, hospitals that target only long-term care patients for early discharge will not substantially gain under PPS because these patients represent a small portion of the cases treated in the hospital and a small percentage of unreimbursed days.

Aged↗
PubMedDate not supplied

The case for national health data standards.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) contains groundbreaking provisions to encourage the development of a national health information system through the establishment of standards. This paper compares statewide inpatient data systems to one standard--the Uniform Bill (UB)--to understand how standards have been used and how they can be improved. We recommend changes to the UB, note the need for better compliance, and suggest new standards for common, derived elements.

Computer Communication Networks↗
PubMedDate not supplied

Spending on mental health and substance abuse treatment, 1987-1997.

This paper is the result of an ongoing effort to track spending on mental health and substance abuse (MH/SA) treatment nationwide. Spending for MH/SA treatment was $85.3 billion in 1997: $73.4 billion for mental illness and $11.9 billion for substance abuse. MH/SA spending growth averaged 6.8 percent a year between 1987 and 1997, while national health expenditures grew by 8.2 percent.

Adult↗