The Paradox of Higher Charges for Lower-Risk Inpatient Admissions:When Healthier Patients Cost More

摘要：

　　Risk stratification is essential to achieving the Triple Aim of better health,better care,and lower costs.Although risk tiers based on chronic disease diagnoses and recent healthcare utilization were predictive of healthcare utilization and charges in a managed population,their correlation with specific highcost outcomes was unknown.More detailed analyses were performed to confirm that admissions for higher-risk patients were more expensive.However,these analyses found that charges for admissions of high-risk patients were actually not more expensive but 33%less expensive.The billing categories of implants,surgery,and supplies accounted for 93%of this difference.These findings may reflect that high-risk patients are less often appropriate candidates for elective surgery.An understanding of this difference,especially if validated by claims data and replicated in other populations,may lead to important insights into using risk stratification for predicting health services utilization in managed care populations.

关键词： Risk Assessment Practice Management Health Services Needs and Demand

作者: Lincoln Sheets Kayson Lyttle Lori L.Popejoy Jerry C.Parker

作者单位: Informatics Institute,University of Missouri,Columbia,Missouri,USA;School of Medicine,University of School of Medicine,University of Missouri,Columbia,Missouri,USA Sinclair School of Nursing,University of Missouri,Columbia,Missouri,USA

会议类型: 国际会议

会议名称: 第十六届世界医药健康信息学大会((MEDINFO2017)、第二届世界医药健康信息学华语论坛(WCHIS 2017)、第15届全国医药信息学大会(CMIA 2017)

会议地点: 苏州

会议语种:英文

页码: 1158-1162

在线出版日期: 2017-08-21（万方平台首次上网日期，不代表论文的发表时间）