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Example: A link to the 2011 spreadsheet of the CMI for all US providers is located here. [5] An analysis of that file shows that there are 3619 hospital records. The number of cases for the hospitals ranges from a low of 1 to a high of 36,282 cases at Florida Hospital in Orlando, FL (Medicare ID 100007). That hospital has a Case Mix Index of 1.57.
Case mix, also casemix and patient mix, is a term used within epidemiology as a synonym for cohort; essentially, a case mix groups statistically related patients. [1] An example case mix might be male patients under the age of 50, who present with a myocardial infarction and also undergo emergency coronary artery bypass surgery .
All-payer rate setting is a price setting mechanism in which all third parties pay the same price for services at a given hospital. [1] It can be used to increase the market power of payers (such as private and/or public insurance companies) versus providers, such as hospital systems , in order to control costs.
HCUP includes multiyear hospital administrative (inpatient, outpatient, and emergency department) data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on health and policy issues at the national, State, and local levels, including cost and quality of health services, medical ...
In the mid-1980s, it was believed that Medicare's hospital prospective payment system with diagnosis-related groups may have led to hospitals' discharging patients to post-hospital care (such as skilled nursing facilities) more quickly than was appropriate, to save money. [10]
For example, a capitated eye care program for 25,000 patients is more viable than a capitated eye program for 10,000 patients. The smaller the roster of patients, the greater the variation in annual costs and the more likely that the costs may exceed the resources of the provider.
Seppala also sent a team to study other clinics around the country. His staff went to facilities in Oregon and Missouri that were offering a mix of medically assisted treatments and 12-step. The team came back optimistic. “They saw in action how this could actually work,” Seppala said.
One example is the convergence of preferred provider organization (PPO) plans offered by Blues and commercial insurers and the point of service plans offered by HMOs. Historically, commercial insurers, Blue Cross and Blue Shield plans, and HMOs might be subject to different regulatory oversight in a state (e.g., the Department of Insurance for ...