Estimating Post-hospital Use for Principal and Secondary Diagnoses
Abstract
One concern with any prospective payment system that bundles payment of post-hospital care with primary hospital care is the possibility that hospital administrators and doctors will learn to predict which types of patients will require post-hospital care. Since any extra post-hospital care would have to be paid by the hospital out of the fixed prospective payment, predictable variation in the use of post-hospital care within payment categories might create an incentive to exclude patients likely to require the most care. This Note demonstrates that knowledge of a patient's secondary diagnoses provides additional information about the patient's use of post-hospital care beyond that contained in the principal diagnosis. Unless a small number of secondary diagnoses can be identified that account for most of this additional variability in post-hospital use, refinement of the current diagnostic related group (DRG) system to account for differences among patients with differing secondary diagnoses will not e feasible. The study provides concrete evidence that knowledgeable administrators can skim desirable patients, not only from the current hospital DRG categories but also from categories defined by the principal diagnoses contained in the current DRG categories.
Document Details
- Document Type
- Technical Report
- Publication Date
- Aug 01, 1990
- Accession Number
- ADA258133
Entities
People
- Joanna Z. Heilbrunn
- Neal Thomas
Organizations
- RAND Corporation