Cornelius E, Feldman J, Marsteller J A, Liu K
Office of Research and Demonstrations, HCFA, Baltimore, MD 21207, USA.
Health Care Financ Rev. 1994 Winter;16(2):101-26.
As Medicare payments for post-acute institutional care continue to rise sharply, policy interest in the clinical characteristics of beneficiaries admitted to nursing homes and their variation across facilities has stimulated research into case mix. Measures of Medicare skilled nursing facility (SNF) case mix are important in relating payments to the care requirements of residents. The Resource Utilization Groups, Version III (RUG-III) classification system uses a new minimum data set that is not currently available nationally. In preparation for a multi-State demonstration, we needed to simulate at least the first-level splits at the national, State, and facility level. Therefore, we developed proxy measures using comparable data available on the National Claims History files. The analog is an easily programmed measure of the acuity/severity of beneficiaries' conditions across a Medicare Part A SNF stay in 75 percent of the SNF providers. This can be a method for estimating changes in case mix over the years, and differences across provider types and States.
随着医疗保险对急性后机构护理的支付持续大幅上升，对入住疗养院的受益人的临床特征及其在不同机构间的差异的政策关注激发了对病例组合的研究。医疗保险熟练护理设施（SNF）病例组合的衡量标准对于将支付与居民的护理需求联系起来很重要。资源利用组第三版（RUG-III）分类系统使用了一个目前全国范围内都没有的新的最小数据集。为筹备一项多州示范项目，我们需要在国家、州和机构层面至少模拟出一级分类。因此，我们利用国家索赔历史文件中可用的可比数据制定了替代指标。该类似指标是一种易于编程的衡量标准，用于评估75%的SNF提供者中医疗保险A部分SNF住院期间受益人的病情严重程度。这可以作为一种估计多年来病例组合变化以及不同提供者类型和州之间差异的方法。
