January 18, 2018

Paying for high intensity inpatient activities

How should hospital reimbursement be refined to support concentration of complex care services?

Concentration of certain inpatient activities is absolutely necessary to guarantee the right efficiency and outcomes that can only be achieved under a large scale. However, how to pay for this is a different and difficult issue. Usually these activities result from a blending of costs of care, teaching costs, and sometimes with research costs. Therefore, the first step is to try to split them as far as possible.
A new paper tries to disentangle in part the issue of how to pay for complex services, and says:
There is no universally agreed definition of what constitutes complex care hospital care, but in England attempts have been made to define complex care according to the  presence of specific diagnoses and procedures in each patient’s medical record. We have applied these complex care definitions to determine whether the receipt of complex care is associated with higher costs relative to patients allocated to the same HRG who did not receive complex care. To do this, we estimate random effects models using patient-level activity and cost data for all patients admitted to English hospitals during the 2013/14 financial year. Compared to otherwise equivalent patients allocated to the same HRG, costs were more than 10% higher for patients receiving 26 (out of 69) types of complex care delivered in hospitals.
And the reason behind these higher costs, maybe severity within the classification or ...