Fischer:
Chances and Problems of Patient Classification Systems.
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Z I M
- Note PCS
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Nov. 1998
Last update: Aug. 1999
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1. Chances of the Usage of a Patient Classification Systems
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Enabling a new culture of constructive dialogue
between clinicians and managers.
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Incentive for hospitals to optimise treatment paths.
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Definition of production units in accounting systems.
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Possibility to describe and measure
(a very relevant part of)
the hospital services.
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Cost containment on case basis.
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Shortening of undue lengths of stay.
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Prospective case payments based on PCSs
are more risk adjusted than payments of fixed daily rates.
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Easier to invoice than fee for service.
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Possibly helpful in quality assurance systems.
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Management decisions at hospital level can be more substantiated.
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2. Problems / Discussion Points of PCS Use
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What is a "case" (treatment unit)?
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Are the criteria of physicians sufficient
which are normally used as
the only relevant cost drivers?
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Is the achieved cost homogeneity acceptable?
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What should be grouped:
the needs of treatment,
the treatment rendered,
or the result of treatment?
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Is there an appropriate adjustment
for severity and multimorbidity?
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Is the PCS approach also useful for treatments
other than surgical treatments?
(In these settings treatment goals can influence
costs substantially. Nevertheless most PCS approaches
ignore treatment goals.)
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The choice of a PCS is not yet
the choice of a remuneration system!
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How are cost weights and prices
defined and maintained?
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How will the financing of hospitals based on PCS
influence other providers, especially primary and community care?
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Classification/remuneration of special services
(e.g. intensiv care, emergency admission)?
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A PCS provides only a label and a code,
but no description of characteristics
of the hospital services.
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Influence on treatment quality?
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Requirements for coding quality?
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Correct choice of principal diagnosis?
(This is only a problem in PCS which use principal
diagnoses, i.e. particularly all DRG based systems;
no problem with systems like PMC or Disease Staging)
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A one-dimensional PCS leads to a large number of groups.
In a multi-dimensional PCS the
number of (base) groups shrinks and it is aggregatable in a
more consistent and more flexible way.
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Possibilities for aggregation?
(Is dependent on the dimensional and hierarchical structures of the PCS.)
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3. Future Developments
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4. References
[1]
Fischer W:
Multidimensionality as an Alternative Approach to Construct Patient Classification Systems.
In: Proceedings of the 14th PCS/E International Working Conference.
Manchester, 1998:294.
[2]
Fischer W:
PCS and Casemix Types.
In: Proceedings of the 11th PCS/E International Working Conference.
Oslo, 1995:50-7.
[3]
Fischer W:
Diagnosis Related Groups (DRGs) im Vergleich zu den Patientenklassifkationssystemen von Österreich und Deutschland
(A Comparison of PCS Construction Principles of the American DRGs, the Austrian LDF System, and the German FP/SE System).
Z/I/M, Wolfertswil 1999: 155 pp.
[4]
Fischer W:
Patientenklassifikationssysteme zur Bildung von Behandlungsfallgruppen im stationären Bereich - Prinzipien und Beispiele
(Patient Classification Systems for Grouping Hospital Cases
- Principles and Examples).
BSV and Z/I/M, Bern and Wolfertswil 1997: 514 pp.
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© Z I M
Source =
http://www.fischer-zim.ch/notes-en/PCS-Chances-Problems-9811.htm
( latest compilation:
27.04.2010
)
Deutscher Text