USING CLAIMS DATA TO MONITOR HOSPITAL UTILIZATION

被引：0
|
作者：
SAAD, AN
ANDREWS, RW
GRIFFITH, JR
机构：
[1] UNIV MICHIGAN,SCH BUSINESS ADM,ANN ARBOR,MI 48109
[2] UNIV MICHIGAN,SCH PUBL HLTH,DEPT HLTH SERV MANAGEMENT,ANN ARBOR,MI 48109
[3] BLUE CROSS & BLUE SHIELD MICHIGAN,HLTH CARE RES & CREDENTIALING,DETROIT,MI 48226
来源：
INQUIRY-THE JOURNAL OF HEALTH CARE ORGANIZATION PROVISION AND FINANCING | 1993年 / 30卷 / 04期
关键词：
D O I：
暂无
中图分类号：
R19 [保健组织与事业（卫生事业管理）];
学科分类号：
摘要：
Controlling provider use is a continuing problem for health care insurers. This paper describes a Blue Cross and Blue Shield of Michigan system that places primary responsibility for inpatient admissions on participating hospitals and uses a dual monitoring approach. Expensive annual samples that review medical records against published criteria constitute the basic test of compliance. An inexpensive indicator is developed;quarterly using automated universal claims review. Statistical methodology, costs, and savings for both monitors are described. The claims monitor uses diagnosis related group (DRG) characteristics to estimate the percentage of inappropriate utilization from historical values for the patient group.
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页码：447 / 454
页数：8
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