Requesting Help with Case-Mix Adjustments?

Posted on May 4, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Question:

I am the quality improvement co-coordinator for a small rural tertiary care center in the Upper Peninsula of Michigan. We are just beginning to implement case-mixes and newer case-mix severity evaluations.

What is the real purpose of medical case-mix adjustments for a physician or healthcare facility; and how should we proceed?

Thank you.

Sarah J. Silvers-Inen

Medical Quality Coordinator

Marquette, MI

Filed under: "Ask-an-Advisor" |

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One Response

  1. Executive-Post, on May 4, 2008 at 1:46 AM said:

    HI SARAH,

    Answer: As you know, the purpose of any case-mix severity adjustment algorithm is in the calculation of the expected value of a measure for a medical provider or healthcare facility. The expected value is what a medical provider “should” obtain based on normative values for the individual case-mix or risk groups.

    For example, a tertiary care center in New York City cannot be compared using unadjusted data with a community hospital in your own town of Marquette. MI. The tertiary care center will use more resources, and thus cost more, than your center no matter how exemplary it may be. And, a cardiologist cannot be compared to a family practitioner, since in general the cardiologist will see patients of greater severity.

    Therefore, to calculate the value, a weighted average is performed where the normative cost, such as a plan average, for each case-mix unit or group is weighted according to the provider’s individual experience.

    Thus, for a provider who saw 50 cases of an expensive disease and 20 cases of an inexpensive disease, the expected value will be much more weighted toward the more resource-intensive illness since more cases were seen. And, in health economics, this is akin to activity-based- medical-costing [ABMC] and medical cost-accounting.

    Medical facilities are evaluated using a similar rationale.
    Good luck with your journey. The books listed below may help.

    Fraternally,
    -Brent A. Metfessel MD, MS, CMP™ (Hon)
    Executive-Post

    Related Information Sources:
    Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759
    Financial Planning: http://www.jbpub.com/catalog/0763745790
    Risk Management: http://www.jbpub.com/catalog/9780763733421
    Healthcare Organizations: http://www.HealthcareFinancials.com
    Administrative Terms: http://www.HealthDictionarySeries.com

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