Adjusting for Nursing Care Case Mix in Hospital Reimbursement

[en] The purpose of this study was to examine and review the different ways in which nursing care can be accounted for in a general hospital reimbursement system. The study is based on a literature review and a survey of international experts. It provides a typology of nursing care adjustment methods, using current and past practices of 14 Western countries as key examples. The results of our review indicate that it is necessary to take the variability of nursing care within DRGs into account, not from a cost-accounting perspective, but from a management perspective in terms of correct resource allocation. However, further investigation of these complex relationships is urgently needed.

Research center :

University Hospital of Liège, Belgium

Disciplines :

Public health, health care sciences & services

Author, co-author :

Laport, Nancy ; SERVICE D'INFORMATIONS MEDICO ECONOMIQUES (SN-5)

Language :

English

Title :

Adjusting for Nursing Care Case Mix in Hospital Reimbursement

Publication date :

May 2008

Journal title :

Policy, Politics, and Nursing Practice

ISSN :

1527-1544

eISSN :

1552-7468

Publisher :

SAGE Publications

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

http://ppn.sagepub.com/cgi/content/abstract/9/2/94

Available on ORBi :

since 19 February 2010

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Bibliography

Anderson, B., & Hannah, K.J. (1993). A Canadian nursing minimum data set: A major priority. Canadian Journal of Nursing Administration, 6, 7-13.
APDRG Suisse. (2005a). Cost-weights et Swisspayment groups: Version 5.1. Retrieved January 18, 2008, from http://www.apdrgsuisse.ch/public/fr/o_rapport_cw_v51b_f.pdf
APDRG Suisse. (2005b). TAR APDRG 2006: Principes et règles de financement et de facturation par APDRG [TAR APDRG 2006: Principles and rules of invoicing and reimbursement per APDRG]. Retrieved January 18, 2008, from http://www.apdrgsuisse.ch/public/fr/rapports.htm
Atwood, J.R., Hinshaw, A.S., & Chance, H.C. (1986). Relationships among nursing care requirements, nursing resources, and charges. In F.A. Shaffer (Eds.), Patients and purse strings: Patient classification and cost management (pp. 99-120). New York: National League for Nursing.
Australian Government Department of Health and Ageing. (2006). National Hospital Cost Data Collection (NHCDC) hospital reference manuals. Round 10 (2005-06). Retrieved January 18, 2008, from: http://www.health.gov.au/internet/wcms/publishing.nsf/content/health-casemix-data-collections-NHCDC-HRMS
Bargagliotti, L.A., & Smith, H. (1985). Patterns of nursing costs with capitated reimbursements. Nursing Economics, 3(5), 270-275.
Berthou, A., & Junger, A. (2000a). Nursing data. Rapport final: étude des travaux 1998-2000 [Final report: Study of work progress 1998-2000]. Lausanne, Switzerland: Institut de santé et d'economie.
Berthou, A., & Junger, A. (2000b). Rapport final nursing data 1998-2000. Lausanne, Switzerland: Institut de santé et d'economie.
Busse, R., Schreyogg, J., & Smith, P.C. (2006). Hospital case payment systems in Europe. Health Care Management Science, 9(3), 211-213.
Canadian Institute for Health Information. ( 2004). DAD resource intensity weights and expected length of stay, 2003 and 2004. Retrieved January 18, 2008, from http://www.icis.ca/cihiweb/dispPage.jsp?cw_page=bl_dad_28sep04_e
Canadian Institute for Health Information. ( 2006). Canadian MIS database hospital financial performance indicators 1999, 2000 to 2003, 2004 and preliminary 2004-2005. Ottawa, Ontario, Canada: Author.
Canadian Nurses Association. (2003). Measuring nurses workload. Nursing Now, 15, 1-4.
Caterinicchio, R.P., & Davies, R.H. (1983). Developing a client-focused allocation statistic of inpatient nursing resource use: an alternative to the patient day. Social Science & Medicine, 17(5), 259-272.
Cromwell, J., & Price, K. (1988). The sensitivity of DRG weights to variation in nursing intensity. Nursing Economics, 6(1), 18-26.
Delesie, L., De Becker, P., & Sermeus, W. (1986). Pilootstudie registratie minimale verpleegkundige gegevens [Pilot study registration of minimal nursing data]. Leuven, Belgium: Katholieke Universiteit Leuven, Centrum voor Ziekenhuiswetenschap.
Department of Health. (2007). NHS costing manual. Retrieved January 18, 2008, from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074472
Dubois-Fresney, C. (1997). Le résumé de soins infirmiers [The summary of nursing care delivery]. Paris: Maloine.
Elo, S. (1995). The public health nursing minimum dataset: Development, application and use. Vard I Norden, 15(3), 9-16.
European Health Management Association. (2006 ). Healthbasket: Health benefits and service costs in Europe: A European research project, April 2004-March 2007. Retrieved January 18, 2008, from http://www.ehma.org/projects
European Hospital and Healthcare Federation. ( 2006). HOPE report on DRGs as a financing tool. Retrieved January 18, 2008, from the HOPE Web site: http://www.hope.be/
Fattore, G., & Torbica, A. (2006). Inpatient reimbursement system in Italy: How do tariffs relate to costs? Health Care Management Science, 9(3), 251-258.
Fetter, R., Shin, Y., Freeman, J., Averill, A., & Thompson, J. (1980). Case mix definition by diagnosis-related groups. Medical Care, 18(3), 1-53.
Fischer, W. (2002). Diagnosis related groups (DRGs) und Pflege: Grundlagen, Codierungssysteme, Integrationsmöglichkeiten [Diagnosis related groups (DRGs) and nursing: Foundations, coding system, possibilities for integration]. Bern, Switzerland: Huber.
Germain, B. (1993). Le résumé de soins infirmiers, utopie ou nécessité? [The summary of nursing care delivery, utopia or necessity?]. Objectif Soins, 14, 50-58.
Goossen, W., Coenen, A., Sermeus, W., Marin, H., Hovenga, E., & Casey, A. (2006). The international nursing minimum data set (i-NMDS). In C. Weaver, C. Delaney, P. Weber, R. Carr (Eds.), Nursing and informatics for the 21st century. An international look at practice, trends and the future (pp. 305-320). Chicago: Healthcare Information and Management Systems Society.
Goossen, W., Delaney, C., & Sermeus, W. (2004, September). Preliminary results of a pilot of the international nursing minimum dataset (i-NMDS). Proceedings of Medinfo 11th World Congress on Medical Informatics of the International Medical Informatics Association.
Green, J., McClure, C.M., Wintfeld, N., Birdsall, C., & Rieder, K.A. (1988). Severity of illness and nursing intensity: Going beyond DRGs. In J.C. Scherubel & F.A. Shaffer (Eds.), Patients and purse strings II (pp. 207-230). New York: National League for Nursing.
Halloran, E.J. (1985). Nursing workload, medical diagnosis related groups, and nursing diagnoses. Research in Nursing and Health, 8(4), 421-433.
Harrell, J.S. (1986). Predicting nursing care costs with a patient classification system. In F.A. Shaffer (Eds.), Patients and purse strings: Patient classification and cost management (pp. 149-164). New York: National League for Nursing.
Hovenga, E., & Hindmarsh, C. (1996, September). Queensland Health-PAIS validation study. Results and issues for nursing cost capture. Proceedings of the Eight Casemix Conference, Sydney, Australia.
International Council of Nurses. (2003). ICN Workforce Forum report, 2003 29th-30th, September. Oslo, Norway: Author.
McKibben, R.C., Brimmer, P.F., Galiher, J.M., Hartley, S.S., & Clinton, J. (1985). Nursing costs and DRG payments. American Journal of Nursing, 85(12), 1353-1356.
Molgaard, E. (2000). Calculation of nursing costs in relation to the DRG-system. Retrieved January 18, 2008, from http://perswww.kuleuven.be/~u0010801/downloads/drgnursingloadmvg.pdf
Nightingale, F. (1860). Notes on nursing. New York: Dover.
Oostenbrink, J.B., & Rutten, F.F. (2006). Cost assessment and price setting of inpatient care in the Netherlands. The DBC case-mix system. Health Care Management Science, 9(3), 287-294.
Paira, A., & Pereira, F. (2006). Nursing minimum dataset in Portugal. Retrieved January 18, 2008, from http://fnaee.pt/index.php?set=links-esenfs
Picone, D. (1995). Casemix and Nursing Quality Project. Canberra, Australia: Commonwealth Department of Human Services and Health.
Picone, D., Ferguson, L., & Hathaway, V. (1993). NSW nursing costing study. Sydney, Australia: Sydney Metropolitan Teaching Hospitals Nursing Consortium.
Schreyogg, J., Stargardt, T., Tiemann, O., & Busse, R. (2006). Methods to determine reimbursement rates for diagnosis related groups (DRG): A comparison of nine European countries. Health Care Management Science, 9(3), 215-223.
Schreyogg, J., Tiemann, O., & Busse, R. (2006). Cost accounting to determine prices: How well do prices reflect costs in the German DRG-system? Health Care Management Science, 9(3), 269-279.
Scott, A. (2003). Irish NMDS as part of research project. Retrieved January 18, 2008, from: http://www.dcu.ie/nursing/decision_making.shtml
Sermeus, W. (2006). De Belgische ziekenhuisfinanciering ontcijferd [The Belgian hospital financing system deciphered]. Leuven, Belgium: ACCO.
Sermeus, W., Weber, P., Chu, S., Fischer, W., & Hunstein, D. (2006). The DRG imperative: Overview and nursing impact. In C. Weaver et al. (Eds.), Nursing informatics for the 21st century: An international look at practice, trends and the future (pp. 231-245). Chicago: Healthcare Information and Management Systems Society.
Sovie, M.D. (1988). Establishing the nursing minimum data set as part of the data requirements for DRGs. In H. Werley & N. Lang (Eds.), Identification of the nursing minimum data set. New York: Springer.
Thompson, J.D., Averill, R.F., & Fetter, R.B. (1979). Planning, budgeting, and controlling-One look at the future: Case-mix cost accounting. Health Services Research, 14, 111-125.
Thompson, J.D., & Diers, D. (1991). Nursing resources. In B.F. Fetter, D.A. Brand, & D. Gamache (Eds.), DRGs: Their design and development (pp. 121-183). Ann Arbor, MI: Health Administration Press.
Tilquin, C. (1989). PRN 87-Measuring the level of nursing care required. Montréal, Quebec, Canada: EROS.
Turtiaenen, A.M., Kinnunen, J., Sermeus, W., & Nyberg, T. (2000). The cross-cultural adaptation of the Belgian nursing minimum dataset to Finnish nursing. Journal of Nursing Management, 8, 281-290.
Welton, J.M. (2006). Paying for nursing care in hospitals. American Journal of Nursing, 106(11), 67-69.
Welton, J.M., & Halloran, E.J. (2005). Nursing diagnoses, diagnosis-related group, and hospital outcomes. Journal of Nursing Administration, 35(12), 541-549.
Welton, J.M., Zone-Smith, L., & Fischer, M.H. (2006). Adjustment of inpatient care reimbursement for nursing intensity. Policy, Politics, & Nursing Practice, 7(4), 270-280.
Werley, H.H., Lang, N.M., & Westlake, S.K. (1986). The nursing minimum data set conference: Executive summary. Journal of Professional Nursing, 2, 217-222.