Case-mix adjustment, claims data quality, and physician profiling.

Abstract

On the surface, there are many ways in which case mix may be considered, but the key to any successful system often lies below the surface, in the way in which the available data feed the systems, and in the operational environment in which the output is to be used. This article will review terminology used in case-mix adjustment and profiling techniques, highlight some dangerous (and avoidable) data pitfalls, and emphasize reasonable goals that can be achieved through the use of case-mix adjusted profiling.