Assignment: Mix of Patients

Assignment: Mix of Patients

Assignment: Mix of Patients

Week 10 assignment Each week, you are required to enter your patient encounters into CORE. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using this template . The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Submissions Area. When submitting your note, be sure to include the reference number from CORE. Submission Details: By the due date assigned enter your patient encounters into CORE and complete at least one SOAP note in the template provided. Name your SOAP note document SU_NSG6340_W10_SOAPLastName_FirstInitial.doc. Include the reference number from CORE in your document. Submit your document to the Submissions Area by the due date assigned.

The recent growth of facilities that specialize in services traditionally offered by general hospitals provides another motivation for analyzing the clinical severity of patients treated in various settings. According to the U.S. General Accounting Office (GAO), the number of hospitals that specialize in specific service lines, such as cardiac, orthopedic, and surgical procedures, tripled between 1990 and March 2003.  The number of ASCs, which often specialize in specific surgical procedures that were historically performed only in hospitals, more than doubled between 1991 and 2001 (from 1,460 to 3,371).  General hospitals are concerned that these specialty facilities will take away their most profitable procedures and most lucrative patients.  If specialty hospitals and ASCs are serving a healthier mix of patients, Medicare and other payers might wish to adjust their payment systems to account for this favorable selection. The GAO found that among patients in the same diagnosis categories, specialty hospitals tended to treat a lower percentage of severely ill patients than general hospitals did.  However, there have not yet been any published studies examining patients’ clinical severity in free-standing ambulatory surgical facilities. As a first step in this direction, this study uses Medicare data to analyze the health status of patients in ASCs and hospital outpatient departments.

STUDY DATA AND METHODS

RISK SCORES.

I used Medicare beneficiaries’ risk scores to compare the medical complexity of patients in ASCs and outpatient departments. The risk scores were derived from the hierarchical condition category (HCC) risk adjustment model, which was developed by Health Economics Research for the CMS.  The scores represent beneficiaries’ expected costliness based on their age, sex, and diagnoses from hospital inpatient, outpatient, and physician visits during the previous year. Because they are based on diagnoses, the risk scores capture the portion of complexity related to comorbidities, rather than disability or other factors.