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S F Jencks

Publications and source records attributed to S F Jencks.

At least 37 records · Page 2Linked to original sources
PubMed1990

Quality assurance.

Explore the source record for details and available documents.

Quality Assurance, Health Care↗
PubMed1990

Accessibility and effectiveness of care under Medicaid.

We suggest a framework for assessing the accessibility, appropriateness, and outcomes of care to Medicaid recipients and review studies in these areas. Evidence is limited, and variation among States and the paucity of national data pose further problems. There is evidence that Medicaid recipients receive less medically necessary care (e.g., prenatal care) than the insured, but evidence on the quality of their care is limited. Differences in payment rates between Medicaid and private insurance appear to explain only part of the variance. Studies have demonstrated major direct effects of diminished access on health status. Evaluation of program changes should focus on health outcomes rather than counts of services rendered.

Child↗
PubMed1989

Developing payment refinements and reforms under Medicare for excluded hospitals.

Four classes of specialty hospitals (children's, psychiatric, rehabilitation, and long-term) and two types of distinct-part units in general hospitals (psychiatric and rehabilitation) have been excluded from the Medicare hospital prospective payment system since it was enacted by Congress in 1983. The number of these facilities and the Medicare dollars expended have more than doubled in less than 5 years, prompting renewed policy interest in developing payment reform. In this context, the substantial research and policy development efforts to refine case-mix classification and payment policies for these facilities are reviewed and examined. Findings are discussed relative to possible legislative and regulatory directions.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Assessing hospital-associated deaths from discharge data. The role of length of stay and comorbidities.

To assess the meaning of hospital-associated death rates, we studied whether mortality within 30 days of hospital admission (30-day mortality) is more informative than inpatient mortality and whether detailed assessment of additional discharge diagnoses helps in understanding death rates. We examined hospitalizations for elderly Medicare patients with principal diagnoses of stroke, bacterial pneumonia, myocardial infarction, and congestive heart failure; these conditions account for 30.8% of Medicare 30-day mortality. Average hospital stays for these conditions were 99.0% longer, and inpatient mortality was 25.0% higher in New York than in California, but 30-day mortality was 1.6% higher in California. We conclude that inpatient death rates depend on length-of-stay patterns and give a biased picture of mortality. Additional diagnoses such as shock and pneumonia were strongly associated with increased mortality, but Medicare data do not reveal which patients had these conditions at the time of admission. Recorded diagnoses of chronic diseases such as hypertension, diabetes mellitus, obesity, benign prostatic hypertrophy, and osteoarthritis were commonly associated with reduced risk of death; such reduced risk is not clinically plausible. Several lines of evidence suggest that chronic disorders are underreported for patients with life-threatening disorders. We recommend great caution in using discharge diagnoses of comorbid conditions to adjust hospital death rates for clinical differences in the patient populations.

Aged↗
PubMed1988

Does receiving referral and transfer patients make hospitals expensive?

In 1984-1985 Medicare data, hospital cost per case was strongly correlated both with the percentage of patients admitted as transfers (r = 0.314, P less than 0.0001) and the hospital's referral index (r = 0.512; P less than 0.0001). These relationships remained highly significant after correcting for the hospital wage level, case mix index, teaching activity, urban or rural location, and number of beds. When individual patients in the same hospital and the same diagnosis-related group (DRG) were compared, charges were 37.5 +/- 0.9% higher for transfer admissions, which accounted for only 31.3% of the higher costs of hospitals that received transfers, and charges were not significantly related to referral status (P greater than 0.10). At least for Medicare patients, therefore, the higher costs of transferred patients accounted for less than one third of the higher costs of hospitals that receive such patients, and the costs associated with referred patients did not account for the higher costs of hospitals receiving referrals. Those hospitals may be more expensive because of the features that attract transfers and referrals.

Costs and Cost Analysis↗
PubMed1987

Refining case-mix adjustment. The research evidence.

We review case-mix adjustment, which is the process of adjusting for differences in the cases treated in different hospitals so that their costs or outcomes can be compared. We examine the Medicare payment system, which rests on case-mix adjustment, and identify areas, including outlier payments, in which payment accuracy might be improved without better measurement of the severity of illness. There is no available measure of severity of illness that would produce a large improvement in the accuracy of Medicare payments if used to supplement or replace the system of diagnosis-related groups. Evidence regarding whether better measurement of severity would substantially change the distribution of payments across hospitals is mixed. Considerable evidence suggests that the intensity of medically appropriate treatment for patients in the same diagnosis-related group varies substantially for reasons other than the severity of illness. Despite great demand for measures of the quality of care, important technical problems must be solved before we can be confident that differences in case-mix-adjusted outcomes reflect differences in the quality of care.

Diagnosis-Related Groups↗
PubMed1987

Do frail, disabled, poor, and very old Medicare beneficiaries have higher hospital charges?

To determine whether basing payments on diagnosis related groups (DRGs) results in mispayment for certain classes of patients, we examined the relation between total Medicare charges per hospitalization and eight beneficiary characteristics (including admission from a nursing home, extreme age, Medicaid enrollment, and disability). We controlled for the hospital in which care was given and the DRG to which the discharge was assigned. The largest effects were that average charges were 6.7% higher for beneficiaries who were disabled before the age of 65 years, and 6.2% higher for patients admitted from a nursing home; charges were 1.5% lower for Medicare beneficiaries who were also enrolled in Medicaid, 3.8% higher for those older than 80 years, and 1.3% lower for those older than 85 years compared with those aged from 80 to 84 years. Because these differences are very small compared with the average variation within DRGs, we conclude that using these beneficiary characteristics in the DRG classification system would only slightly improve DRGs. Medicare's DRG-based payments seem to be substantially equitable with regard to these beneficiary characteristics.

Aged↗
PubMed1985

Recognition of mental distress and diagnosis of mental disorder in primary care.

Data from the National Ambulatory Medical Care Survey show that the majority of psychotropic drugs and "psychotherapy/therapeutic listening" provided to adults in office-based primary care are given in visits during which no diagnosis of mental disorder is recorded. This finding is not explained either by a general tendency of surveyed physicians to record drug treatment without an appropriate diagnosis or by management of specific nonmental disorders with mental treatments. Patients who receive treatment without diagnosis tend to be older, established patients with established diagnoses who see the physician for a shorter visit and are more likely to have a follow-up appointment. The data do not provide evidence as to whether mental treatment without mental diagnosis results from inadequacies in the current diagnostic system, inadequacies of physician knowledge and skills, or other factors. Further clarification of this issue will require new research models.

Adult↗
PubMed1985

Challenges in bringing exempt psychiatric services under a prospective payment system.

By December 31, 1985, the Secretary of the Department of Health and Human Services must report to Congress on whether psychiatric programs now exempt from Medicare's prospective payment system can be brought under that system, and if so, how. The underlying issue is determining how funds for psychiatric treatment should be divided up between psychiatric facilities. After discussing the advantages of incorporating psychiatric services into the prospective payment system, the authors review the criteria and methods for evaluating a psychiatric prospective payment system and suggest ways that the current classification and payment systems can be improved. Steps to ease the transition to prospective payment are reviewed, as are issues requiring further research.

Costs and Cost Analysis↗
PubMed1984

Evaluating and improving the measurement of hospital case mix.

The foundation of case-based prospective payment is the case classification system. The purpose of classification systems is to group together patients with similar treatment requirements. The systems described in this issue take a variety of theoretical and practical approaches to classification. The critical issue in comparing these systems is whether the variation in treatment requirements which is not explained by the classification system is associated with particular groups of patients, particular hospitals, or particular groups of hospitals in such a way as to result in unfair reimbursement. We suggest criteria for comparing classification systems and a research agenda for clarifying the fairness of different approaches.

Costs and Cost Analysis↗
PubMedDate not supplied

Interpreting hospital mortality data. The role of clinical risk adjustment.

This study uses national Medicare data as well as data that were abstracted to calibrate the Medicare Mortality Predictor System to assess the usefulness of a risk adjustment system in interpreting hospital mortality rates. The majority of variation in annual hospital death rates for the four conditions studied (stroke, pneumonia, myocardial infarction, and congestive heart failure) is chance variability that results from the relatively small numbers of patients treated in most hospitals in a year. For hospitals in the highest and lowest quartiles of observed death rates, the difference between observed rates and those predicted by the Medicare Mortality Predictor System is not quite on third smaller than the difference between observed rates and unadjusted national rates. Risk adjustment methods do not show whether the unexplained difference in mortality rates results from differences in effectiveness of care or unmeasured differences in patient risk at the time of admission. Risk-adjusted mortality rates, therefore, should be supplemented by review of the actual care rendered before conclusions are drawn regarding effectiveness of care.

Aged↗