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Biomedical subjects

S F Jencks

Publications and source records attributed to S F Jencks.

16 recordsLinked to original sources
PubMed1990

Impact of the Medicare fee schedule on payments to physicians.

Beginning in 1992, the Medicare program will pay physicians by the Medicare Fee Schedule, a system of geographically adjusted standardized payment rates based in part on the Resource-Based Relative Value Scale developed by Hsaio et al and in part on current Medicare payments. In our simulations of the Medicare Fee Schedule, we find that (1) redistributions of Medicare-allowed charges across specialities will be substantial but approximately only half the size projected by Hsaio, (2) there will be large redistributions among geographic areas that tend to compound the specialty redistributions, and (3) there will be wide variation within specialties as to how individual providers are affected. The majority of the redistributive impact of the Medicare Fee Schedule is attributable to implementation of a geographically adjusted system of standardized payments rather than to the particular work values developed by Hsiao et al in the Resource-Based Relative Value Scale.

Costs and Cost Analysis↗
PubMed1990

Quality assurance.

Explore the source record for details and available documents.

Quality Assurance, Health Care↗
PubMed1988

Assessing hospital-associated deaths from discharge data. The role of length of stay and comorbidities.

To assess the meaning of hospital-associated death rates, we studied whether mortality within 30 days of hospital admission (30-day mortality) is more informative than inpatient mortality and whether detailed assessment of additional discharge diagnoses helps in understanding death rates. We examined hospitalizations for elderly Medicare patients with principal diagnoses of stroke, bacterial pneumonia, myocardial infarction, and congestive heart failure; these conditions account for 30.8% of Medicare 30-day mortality. Average hospital stays for these conditions were 99.0% longer, and inpatient mortality was 25.0% higher in New York than in California, but 30-day mortality was 1.6% higher in California. We conclude that inpatient death rates depend on length-of-stay patterns and give a biased picture of mortality. Additional diagnoses such as shock and pneumonia were strongly associated with increased mortality, but Medicare data do not reveal which patients had these conditions at the time of admission. Recorded diagnoses of chronic diseases such as hypertension, diabetes mellitus, obesity, benign prostatic hypertrophy, and osteoarthritis were commonly associated with reduced risk of death; such reduced risk is not clinically plausible. Several lines of evidence suggest that chronic disorders are underreported for patients with life-threatening disorders. We recommend great caution in using discharge diagnoses of comorbid conditions to adjust hospital death rates for clinical differences in the patient populations.

Aged↗
PubMed1988

Does receiving referral and transfer patients make hospitals expensive?

In 1984-1985 Medicare data, hospital cost per case was strongly correlated both with the percentage of patients admitted as transfers (r = 0.314, P less than 0.0001) and the hospital's referral index (r = 0.512; P less than 0.0001). These relationships remained highly significant after correcting for the hospital wage level, case mix index, teaching activity, urban or rural location, and number of beds. When individual patients in the same hospital and the same diagnosis-related group (DRG) were compared, charges were 37.5 +/- 0.9% higher for transfer admissions, which accounted for only 31.3% of the higher costs of hospitals that received transfers, and charges were not significantly related to referral status (P greater than 0.10). At least for Medicare patients, therefore, the higher costs of transferred patients accounted for less than one third of the higher costs of hospitals that receive such patients, and the costs associated with referred patients did not account for the higher costs of hospitals receiving referrals. Those hospitals may be more expensive because of the features that attract transfers and referrals.

Costs and Cost Analysis↗
PubMed1987

Refining case-mix adjustment. The research evidence.

We review case-mix adjustment, which is the process of adjusting for differences in the cases treated in different hospitals so that their costs or outcomes can be compared. We examine the Medicare payment system, which rests on case-mix adjustment, and identify areas, including outlier payments, in which payment accuracy might be improved without better measurement of the severity of illness. There is no available measure of severity of illness that would produce a large improvement in the accuracy of Medicare payments if used to supplement or replace the system of diagnosis-related groups. Evidence regarding whether better measurement of severity would substantially change the distribution of payments across hospitals is mixed. Considerable evidence suggests that the intensity of medically appropriate treatment for patients in the same diagnosis-related group varies substantially for reasons other than the severity of illness. Despite great demand for measures of the quality of care, important technical problems must be solved before we can be confident that differences in case-mix-adjusted outcomes reflect differences in the quality of care.

Diagnosis-Related Groups↗
PubMed1987

Do frail, disabled, poor, and very old Medicare beneficiaries have higher hospital charges?

To determine whether basing payments on diagnosis related groups (DRGs) results in mispayment for certain classes of patients, we examined the relation between total Medicare charges per hospitalization and eight beneficiary characteristics (including admission from a nursing home, extreme age, Medicaid enrollment, and disability). We controlled for the hospital in which care was given and the DRG to which the discharge was assigned. The largest effects were that average charges were 6.7% higher for beneficiaries who were disabled before the age of 65 years, and 6.2% higher for patients admitted from a nursing home; charges were 1.5% lower for Medicare beneficiaries who were also enrolled in Medicaid, 3.8% higher for those older than 80 years, and 1.3% lower for those older than 85 years compared with those aged from 80 to 84 years. Because these differences are very small compared with the average variation within DRGs, we conclude that using these beneficiary characteristics in the DRG classification system would only slightly improve DRGs. Medicare's DRG-based payments seem to be substantially equitable with regard to these beneficiary characteristics.

Aged↗
PubMed1985

Recognition of mental distress and diagnosis of mental disorder in primary care.

Data from the National Ambulatory Medical Care Survey show that the majority of psychotropic drugs and "psychotherapy/therapeutic listening" provided to adults in office-based primary care are given in visits during which no diagnosis of mental disorder is recorded. This finding is not explained either by a general tendency of surveyed physicians to record drug treatment without an appropriate diagnosis or by management of specific nonmental disorders with mental treatments. Patients who receive treatment without diagnosis tend to be older, established patients with established diagnoses who see the physician for a shorter visit and are more likely to have a follow-up appointment. The data do not provide evidence as to whether mental treatment without mental diagnosis results from inadequacies in the current diagnostic system, inadequacies of physician knowledge and skills, or other factors. Further clarification of this issue will require new research models.

Adult↗
PubMed1985

Challenges in bringing exempt psychiatric services under a prospective payment system.

By December 31, 1985, the Secretary of the Department of Health and Human Services must report to Congress on whether psychiatric programs now exempt from Medicare's prospective payment system can be brought under that system, and if so, how. The underlying issue is determining how funds for psychiatric treatment should be divided up between psychiatric facilities. After discussing the advantages of incorporating psychiatric services into the prospective payment system, the authors review the criteria and methods for evaluating a psychiatric prospective payment system and suggest ways that the current classification and payment systems can be improved. Steps to ease the transition to prospective payment are reviewed, as are issues requiring further research.

Costs and Cost Analysis↗
PubMedDate not supplied

Interpreting hospital mortality data. The role of clinical risk adjustment.

This study uses national Medicare data as well as data that were abstracted to calibrate the Medicare Mortality Predictor System to assess the usefulness of a risk adjustment system in interpreting hospital mortality rates. The majority of variation in annual hospital death rates for the four conditions studied (stroke, pneumonia, myocardial infarction, and congestive heart failure) is chance variability that results from the relatively small numbers of patients treated in most hospitals in a year. For hospitals in the highest and lowest quartiles of observed death rates, the difference between observed rates and those predicted by the Medicare Mortality Predictor System is not quite on third smaller than the difference between observed rates and unadjusted national rates. Risk adjustment methods do not show whether the unexplained difference in mortality rates results from differences in effectiveness of care or unmeasured differences in patient risk at the time of admission. Risk-adjusted mortality rates, therefore, should be supplemented by review of the actual care rendered before conclusions are drawn regarding effectiveness of care.

Aged↗