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UTS - 92917 Using Health Care Data for Decision Making

   

Added on  2019-10-30

8 Pages1570 Words197 Views
1Using health care data in decision makingNameCourseProfessorSchoolCityDate

21.BackgroundAs the HIM’s assistance I Intend to examine the UTS hospital data and provide the following summary based on these parameters as below; Definitions for per-diem and casemix funding.Per-diem refers to the daily allowance of a given amount of money which an organization offers individuals based on the case study (patients), per day in order to cover the medical expenses for the patients to enable them get treatment in a given day (Drummond, Sculpher, Claxton, Stoddartand Torrance, 2015). On the other hand casemix funding refers to the technique of allocating of funding which is based on the activities the hospital undertake, and on the type as well as the number of patients who are treated (Gale, Heath, Cameron, Rashid and Redwood, 2013). The funding is located based on the relative cost of the patients who are treated. Case mix group statistically related patients. An example case might could be patient under 50 years. Description of the differences of these two funding models.Casemix funding model describe the type of mix of the patients who are treated, in regards to prognosis or resources, depending on the parameter of interest. In terms of the healthcare fundingmodel in UTS hospital it classifies individuals into various groups which are homogenous in their resources (Groves, Kayyali, Knott and Kuiken, 2016). When one looks at per-diem model isthe payment for inpatient services offers fixed amount to the patient day in the hospital, which is regardless to the charges of the hospital or cost incurred in caring to a given patient. The payer who is the insurance company negotiates per diem rates with the hospital and pays that rates without any adjustment. In case the insurance and hospital are able to predict accurately the number of the mix of cases they could accurately calculate per diem rate.

3Pros and cons of the casemix-based funding approach compared to a fixed per diem rate.Pros On the advantage of casemix based approach provides the basis for reimbursement and it is significant when comparing facilities or programmes, practices and the outcomes of the patients unlike fixed per diem rate which focus on negotiated rate with the insurer (Jacobs, 2014). Another advantage is that the hospital can increase on their volume of services they offer and hence more benefit from the increased revenue (Groves, Kayyali, Knott and Kuiken, 2016). When compared to the fixed per diem rate the insurance organization only pays at the rate which they negotiate which can be reviewed when an year ends, which means it can go high or lower. Another advantage is that Casemix funding method can be useful benching marking mechanism by which the prices could be set especially for all types of surgical procedures as well as other hospital services (Groves, Kayyali, Knott and Kuiken, 2016). On the other hand, when looking atthe fixed per diem rate there are various multiple per diem which are negotiated based on the service and they diminish the payers need to formulate outlier provisions particularly unusually costly patients. Cons One of the disadvantage is that casemix approach is not the best method to record on the performance of the hospital as they do not suit the type of patients who are treated by UTS hospital as majority of the patients are older and more complex, and they require to stay longer than average length for each AR-DRG (Groves, Kayyali, Knott and Kuiken, 2016). On the other hand when you look at fixed per diem rate it is subjected to a negotiated contract in which the payer has been obligated to pay for the days, regardless to the medical necessity of the patients.

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