Comparing case-mix systems for nursing home payment

TitleComparing case-mix systems for nursing home payment
Publication TypeJournal Article
Year of Publication1990
AuthorsFries B.E
JournalHealth Care Financing Review
Volume11
Issue4
Pagination103-19
Date PublishedSummer
Accession Number10113396
Keywords*Diagnosis-Related Groups, *Long-Term Care/cl [Classification], *Nursing Homes/ut [Utilization], Comparative Study, Evaluation Studies, Health Resources/sd [Supply & Distribution], Models, Theoretical, Statistics, United States
Abstract

Case-mix systems for nursing homes use resident characteristics to predict the relative use of resources. Seven systems are compared in structure, accuracy in explaining resource use, group homogeneity, and ability to identify residents receiving heavy care. Resource utilization groups, version II (RUG-II), was almost uniformly the best system, although management minutes and the Minnesota case-mix system were also highly effective. Relative weights for case-mix groups were sensitive to cost differences and should be recomputed for new applications. Multiple criteria should be used in choosing a case-mix system, including consideration of inherent incentives and how residents' characteristics are defined.

Alternate JournalHealth Care Financ Rev