Severity of Illness Measures: Opportunities for Clinicians (1988)

Editorials15 November 1988Severity of Illness Measures: Opportunities for CliniciansJames B. Couch, MD, JD, David B. Nash, MD, MBAJames B. Couch, MD, JDSearch for more papers by this author, David B. Nash, MD, MBASearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-109-10-771 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe prospective payment system for health services for Medicare beneficiaries has reversed the tide of "pay-as-you-go" reimbursement (1). In addition to the Medicare program, several state medical assistance programs and private health insurance plans have adopted this method of setting reimbursement in advance. Through prospective reimbursement, providers have gained the ability to analyze the costs of care more systematically, and usefully. But those who pay for the provision of health-care services—insurers, managed care organizations, corporations, labor unions, governmental agencies, consumers—also gained this ability. These purchasers are now beginning to demand accountability from providers for the quality and efficiency ("value") of...References1. Vladeck B. Medicare hospital payment by diagnosis-related groups. Ann Intern Med. 1984;100:576-91. LinkGoogle Scholar2. Horn S. Measuring severity of illness: comparisons across institutions. Am J Public Health. 1983;73:25-31. CrossrefMedlineGoogle Scholar3. Gonnella J, Hornbrook M, and Louis D. Staging of disease. JAMA. 1984;251:637-44. CrossrefMedlineGoogle Scholar4. Young W, Swinkola R, and Zorn D. The measurement of hospital case mix. Med Care. 1982;20:501-12. CrossrefMedlineGoogle Scholar5. Knaus W, Draper E, Wagner D, and Zimmerman J. APACHE II: a severity of disease classification system. Crit Care Med. 1985:13:818-29. CrossrefMedlineGoogle Scholar6. Brewster A, Karlin B, Hyde L, Jacobs C, Bradbury R, and Chase Y. MEDISGROUPS: a clinically based approach to classifying hospital patients at admission. Inquiry. 1985;22:377-87. MedlineGoogle Scholar7. Roberts J and Prevost J. Using outcome indicators to evaluate quality of care. The Internist. 1987;28:10-15. MedlineGoogle Scholar8. Horn S, Horn R, and Moses H. Profiles of physician practice and patient severity of illness. Am J Public Health. 1986;76:532-5. CrossrefMedlineGoogle Scholar9. Gilbert B. Relating quality assurance to credentials and privileges. QRB. 1984;10:130-5. MedlineGoogle Scholar10. Roberts J, Radany M, and Nash D. Privilege delineation in a demanding new environment. Ann Intern Med. 1988;108:880-6. LinkGoogle Scholar11. Hershey N. Applying utilization review findings in medical staff appointment and reappointment decisions. Qual Assur Util Rev. 1986;1:109-12. CrossrefMedlineGoogle Scholar12. Knaus W, Draper E, Wagner D, and Zimmerman J. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med. 1986;104:410-8. LinkGoogle Scholar13. McMahon L and Billi J. Measurement of severity of illness and the Medicare prospective payment system: state of the art and future directions. J Gen Intern Med. 1988;3:482-90. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: James B. Couch, MD, JD; David B. Nash, MD, MBAThe authors affirm that they have no financial interest in any of the proprietary systems mentioned here and they do not endorse or recommend any one method. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEvaluation of a Formulary Change on Outcome of Infection and Antimicrobial Resistance in a Medical Intensive Care UnitEvaluation of clinical practice guidelines on outcome of infection in patients in the surgical intensive care unitCharacterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection: The ODIN modelMedical Purchasing Guidelines for the Business Community: How to Ask the Questions and Get the Answers We NeedPredicting Patient Outcome from Intensive Care: A Guide to APACHE, MPM, SAPS, PRISM, and Other Prognostic Scoring SystemsAPACHE: A Nonproprietary Measure of Severity of IllnessWilliam A. Knaus, MD, Douglas P. Wagner, PhD 15 November 1988Volume 109, Issue 10Page: 771-773KeywordsHealth insuranceMedical servicesMedicare ePublished: 1 December 2008 Issue Published: 15 November 1988 PDF downloadLoading ...