Risk Adjustment Based Upon Resource Utilization

Risk Adjustment Based Upon Resource Utilization

Patricia Cerrito (University of Louisville, USA)
DOI: 10.4018/978-1-60566-752-2.ch007
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Resource utilization is based upon the assumption that patients with more severe problems will utilize more resources, and the most severe patients will require the most resources. This type of index assumes that no unnecessary resources are utilized and that treatments, medications, and laboratory diagnostics are required because of the severity of the patient condition. However, if the provider is extravagant in the use of resources, the patient will look severe. Then, too, some of the resources used will depend upon the admitting condition.
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Resources In The Meps Data

The MEPS dataset contains very detailed information about reimbursements from payers, including payments by patients, insurers, and government agencies. Therefore, we can look at the relationship between actual reimbursements to patient condition. Moreover, the patient conditions are very detailed and include any ICD9 code that was used to diagnose a patient in the course of a one-year period. Therefore, we can examine actual resource utilization in relationship to patient diagnoses, to the other indices, and to primary and secondary procedures. We can also examine the resource utilization by state and federal governments, by private insurers, and by the patient.

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