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Biomedical subjects

N Goldfield

Publications and source records attributed to N Goldfield.

At least 19 recordsLinked to original sources
PubMed1999

The prospective risk adjustment system.

The Episode Classification System is intended to perform two tasks. First, it will be a prospective capitation risk adjuster and predict future health care costs. It will do this by assigning each individual a single capitation risk adjustment category based on an analysis of the medical history and of health care services rendered during a specific period of time. Second, the Episode Classification System will create retrospective severity adjusted Episodes of illness or Episodes of Care. These latter Episodes will provide a framework for relating patient characteristics to the amount, type, and duration of services provided during the treatment of a specific disease. These Episodes will give users the ability to understand past costs and the risk of mortality. As such they will form the basis for provider profiling by allowing users to analyze a complete clinical episode.

Actuarial Analysis↗
PubMed1997

Evaluation of a prospective payment system for hospital-based outpatient care.

The design of a prospective payment system (PPS) for outpatient care based on ambulatory patient groups (APGs) requires numerous policy decisions to be made. The policy issues include the method of computing payment weights, the extent of ancillary packaging, the window of time for ancillary packaging, the extent of multiple procedure discounting, and the outlier policy. Financial simulations of an APG-based outpatient PPS were performed in order to evaluate the impact of alternative policy decisions. Recommendations are made relative to each policy issue.

Ambulatory Care↗
PubMed1997

The clinical development of an ambulatory classification system: version 2.0 Ambulatory Patient Groups.

In 1995, the Health Care Financing Administration submitted a Report to Congress recommending the Ambulatory Patient Groups (APGs), or an APG-like patient classification system, be used as the basis of a Medicare outpatient prospective payment system (PPS). Version 2.0 of APGs has been developed in anticipation of its potential use in a Medicare outpatient PPS. The development process and final structure of Version 2.0 of the APGs is described.

Ambulatory Care↗
PubMed1997

Continuous quality improvement at the crossroads: contradictions and challenges.

Continuous quality improvement stands at a crossroads. One road is dominated by the frenzied competition in the current health care marketplace. Another road is traveled both by a desire to compete against disease and by vulnerable employees, many of whom are represented by a weakened union movement. This article reviews this history and lessons and its relationship to CQI. Employee involvement, not just from a psychologic, but also a decision-making and even ownership perspective is necessary for CQI to succeed in the long term. Only with this type of involvement in hand can the trust between employee and employer required for genuine CQI be created.

Communism↗
PubMed1996

The hubris of health status measurement: a clarification of its role in the assessment of medical care.

Numerous advances in health status measurement have occurred in the past several years. Of the many challenges, one, in particular, is important for any health reform proposal to succeed. That is, while many researchers point to health status measures as a means of evaluating outcomes of competing health plans, this paper outlines difficulties with such a proposal. The paper then provides different suggestions for dealing with this important issue. Most notably, a community based health status assessment is recommended.

Competitive Medical Plans↗
PubMed1996

The Clinton health care proposal: reform squandered again!

Unlike the other articles in this series on efforts to reform the American health care system, this article is necessarily somewhat personal. I lived through it--not as a participant in the process but as a very interested bystander. To President Clinton's credit, his proposal was the first comprehensive proposal from a President since at least President Nixon and strictly speaking since President Truman. Yet, in the final analysis, the results were extremely depressing, not merely because of the obvious failure of the effort, but, even more important, because of the impact it has had on Americans' belief in the possibility for significant government role/responsibility in health care or, for that matter, in any significant domestic initiative. This article will trace portions of the failed Clinton health care initiative proposal--not the myriad other proposals that percolated through Congress. Realistically, only a proposal that had the support of the President had any chance of legislative success. This article will trace the development of the proposal and, while focusing on the universal coverage aspect, point to critical decisions that led to its legislative demise.

Health Care Reform↗
PubMed1996

The use of administrative data as the first step in the continuous quality improvement process.

Billing or claims data, commonly referred to as administrative data, can be a valuable tool as the first step in a continuous quality improvement process. It is an inexpensive source of information which allows providers to identify opportunities for improvement in the process and the outcomes of health care delivery. The All Patient Refined/Diagnosis-Related Group case mix or severity-adjusted data represents one tool. The Practice Review System of Value Health Sciences is another. Comparative information is the first step, and the first step only in the quality improvement process. As such, to meet the needs of all continuous quality improvement customers, it is necessary to make this first step as reliable, yet inexpensive, as possible. Completing all the steps requires the use of a several measures over time.

Comorbidity↗
PubMed1994

Case mix, risk adjustment, reinsurance, and health reform.

Case mix measures represent the fundamental tool that measures clinical differences in groups of patients. It is important to be careful how these measures are used, as quality of care delivered to patients is at stake. Risk adjustment methodologies are excellent for physician profiling if one adopts them as the first step in the quality improvement process. Differences in hospital or primary care practice profiles, adjusted for the case mix measures, often reveal quality improvement opportunities. This first step is the easy part. The hard part comes in working together with the health care team to determine the sources for these differences. After identifying and implementing solutions, the quality improvement process just continues. As benefits true commitment to quality improvement, risk assessment methodologies will only improve. In turn, this will provide the health care team with a greater ability to deal with "treasures" uncovered by applying case mix measures.

Actuarial Analysis↗