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Biomedical subjects

R F Averill

Publications and source records attributed to R F Averill.

At least 19 recordsLinked to original sources
PubMed2001

Development of the ICD-10 procedure coding system (ICD-10-PCS).

The International Classification of Diseases 10th Revision Procedure Classification System (ICD-10-PCS) has been developed as a replacement for Volume 3 of the International Classification of Diseases 9th Revision. The development of ICD-10-PCS was funded by the U.S. Health Care Financing Administration. ICD-10-PCS has a multi-axial seven character alphanumerical code structure, which provides a unique code for all substantially different procedures and which allows new procedures to be easily incorporated as new codes. ICD-10-PCS was under development for over five years and the initial draft was formally tested and evaluated by an independent contractor. The final version of the ICD-10-PCS was released in the spring of 1998. The design, development and testing of ICD-10-PCS are discussed.

Abstracting and Indexing↗
PubMed1998

Public dissemination of provider performance comparisons in the United States.

As competition among healthcare providers has increased in the U.S., there has been a rapid growth in the amount of comparative information on provider performance made available to consumers. This availability requires hospitals to have information systems that will allow them to prepare proactively for the public dissemination of comparative performance data. The information contained in provider report cards can be a valuable tool for hospitals to use for internal management and planning.

Benchmarking↗
PubMed1998

Development of the ICD-10 Procedure Coding System (ICD-10-PCS).

The ICD-10 Procedure Coding System (ICD-10-PCS) has been developed as a replacement for Volume 3 of ICD-9-CM. This article will describe the development and structure of ICD-10-PCS--as well as describe the modifications that have been made to the system as a result of extensive review and testing.

Abstracting and Indexing↗
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↗
PubMed1996

Achieving short-term Medicare savings through the expansion of the prospective payment system.

This article addresses the introduction of competition into the Medicare prospective payment system (PPS), the application of aa expanded PPS to ensure that Medicare is not paying more than the market price for comparable services, the expansion of the Medicare PPS to outpatient services, and the expansion of the Medicare PPS to physician fees for inpatient care.

Ambulatory Care↗
PubMed1994

The evolution of case-mix measurement using DRGs: past, present and future.

The Diagnosis Related Groups patient classification scheme has been evolving for over twenty years. The wide variety of DRG applications in the U.S. has resulted in the development of three major versions of DRGs. The alternative DRG systems are described and compared. Comparative statistical data for each DRG system are presented.

Cost Control↗
PubMed1993

Design of a prospective payment patient classification system for ambulatory care.

The Ambulatory Patient Group (APGs) are a patient classification system that was developed to be used as the basis of a prospective payment system (PPS) for the facility costs of outpatient care. This article will review the key characteristics of a patient classification system for ambulatory care, describe the APG development process, and describe a payment model based on the APGs. We present the results of simulating the use of APGs in a prospective payment system, and conclude with a discussion of the implementation issues associated with an outpatient PPS.

Ambulatory Care↗
PubMed1992

A study of the relationship between severity of illness and hospital cost in New Jersey hospitals.

In response to concerns over the equity of diagnosis-related group (DRG)-based prospective payment, the New Jersey Department of Health conducted a Severity of Illness evaluation study in which severity of illness, DRG, and uniform cost information were collected for 76,798 patients in 25 hospitals. Severity of illness was measured using the Computerized Severity Index (CSI) and was found to be a significant determinant of hospital cost in 76 DRGs that accounted for 41.4 percent of the total direct hospital patient care costs and 27 percent of the patients. The addition of CSI severity levels to the 76 DRGs reduced the coefficient of variation of cost in these DRGs by 17.4 percent and improved the overall reduction in variance of cost within the 76 DRGs by 38.2 percent. The change in total hospital payments due to the addition of severity for the 76 DRGs varied from a positive 5.71 percent to a negative 5.48 percent. These results demonstrate that a severity adjustment to this subset of DRGs would result in a more equitable DRG-based prospective payment system.

Diagnosis-Related Groups↗
PubMed1991

The relationship between severity of illness and hospital length of stay and mortality.

To address the question of quantification of severity of illness on a wide scale, the Computerized Severity Index (CSI) was developed by a research team at the Johns Hopkins University. This article describes an initial assessment of some aspects of the validity and reliability of the CSI on a sample of 2,378 patients within 27 high-volume DRGs from five teaching hospitals. The 27 DRGs predicted 27% of the variation in LOS, while DRGs adjusted for Admission CSI scores predicted 38% and DRGs adjusted for Maximum CSI scores throughout the hospital stay predicted 54% of this variation. Thus, the Maximum CSI score increased the predictability of DRGs by 100%. We explored the impact of including a 7-day cutoff criterion along with the Maximum CSI score similar to a criterion used in an alternative severity of illness measure. The DRG/Maximum CSI score's predictive power increased to 63% when the 7-day cutoff was added to the CSI definition. The Admission CSI score was used to predict in-hospital mortality and correlated R = 0.603 with mortality. The reliability of Admission and Maximum CSI data collection was high, with agreement of 95% and kappa statistics of 0.88 and 0.90, respectively.

Diagnosis-Related Groups↗
PubMed1989

Evolution of DRGs and clinical information systems.

DRG definitions have evolved during the past decade and will continue to evolve as methods for evaluating severity data become available. The use of DRGs for hospital budgeting, payment and evaluation as well as the support of hospital utilization review and quality assurance activities requires that systems be available to insure data quality. A comprehensive and flexible clinical information system will be required by hospitals in order to manage under a DRG system.

Adult↗