Mabotuwana Thusitha, Hall Christopher S, Flacke Sebastian, Thomas Shiby, Wald Christoph
Radiology Solutions, Philips Healthcare, 3000 Minuteman Rd, Andover, MA, 01810, USA.
Department of Radiology, Lahey Hospital & Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA.
J Digit Imaging. 2017 Jun;30(3):301-308. doi: 10.1007/s10278-017-9944-y.
With ongoing healthcare payment reforms in the USA, radiology is moving from its current state of a revenue generating department to a new reality of a cost-center. Under bundled payment methods, radiology does not get reimbursed for each and every inpatient procedure, but rather, the hospital gets reimbursed for the entire hospital stay under an applicable diagnosis-related group code. The hospital case mix index (CMI) metric, as defined by the Centers for Medicare and Medicaid Services, has a significant impact on how much hospitals get reimbursed for an inpatient stay. Oftentimes, patients with the highest disease acuity are treated in tertiary care radiology departments. Therefore, the average hospital CMI based on the entire inpatient population may not be adequate to determine department-level resource utilization, such as the number of technologists and nurses, as case length and staffing intensity gets quite high for sicker patients. In this study, we determine CMI for the overall radiology department in a tertiary care setting based on inpatients undergoing radiology procedures. Between April and September 2015, CMI for radiology was 1.93. With an average of 2.81, interventional neuroradiology had the highest CMI out of the ten radiology sections. CMI was consistently higher across seven of the radiology sections than the average hospital CMI of 1.81. Our results suggest that inpatients undergoing radiology procedures were on average more complex in this hospital setting during the time period considered. This finding is relevant for accurate calculation of labor analytics and other predictive resource utilization tools.
随着美国医疗支付改革的不断推进，放射科正从当前作为创收部门的状态转变为成本中心的新现实。在捆绑支付方式下，放射科并非针对每一项住院检查都能获得报销，而是医院根据适用的诊断相关分组代码，就整个住院期间获得报销。医疗保险和医疗补助服务中心定义的医院病例组合指数（CMI）指标，对医院住院期间的报销金额有重大影响。通常，病情最严重的患者在三级医疗放射科接受治疗。因此，基于全体住院患者计算的平均医院CMI可能不足以确定科室层面的资源利用情况，比如技术人员和护士的数量，因为病情较重的患者住院时间和人员配备强度都相当高。在本研究中，我们基于接受放射检查的住院患者，确定了一家三级医疗机构中整个放射科的CMI。2015年4月至9月期间，放射科的CMI为1.93。在十个放射科分支中，介入神经放射学的CMI最高，平均为2.81。七个放射科分支的CMI始终高于医院平均CMI的1.81。我们的结果表明，在所考虑的时间段内，在这家医院环境中接受放射检查的住院患者平均病情更为复杂。这一发现对于准确计算劳动力分析和其他预测资源利用工具具有重要意义。
