Projecting corporate Health plan utilization and charges from annual ICD-9-CM diagnostic rates : A value-added opportunity for pathologists.
College of American Pathologists Foundation Conference on Patient-Centered Pathology Practice : Outcomes and Accountability. , 1997/02/01.
- To develop an allocation method for corporate health plan resources and expenditures based on annual International Classification of Disease, 9th revision, Clinical Modification (ICD-9-CM) diagnostic rate stratification as a surrogate for disease incidence.
- A data-mining process was applied to a self-insured corporate health plan database.
Annual membership rates of Current Procedural Terminology (CPT) procedure utilization and charges between 1990 and 1994 for a cohort of 7216 continuously employed plan members were stratified according to the annual rates of the 19 major ICD-9-CM diagnostic classifications.
The stratified annual CPT utilization and charge rates were analyzed by correlation analysis and one-tailed t test.
- Laboratory and pathology procedure utilization and charge rates were highly correlated with specific rankings of ICD-9-CM diagnostic classifications.
The health plan diagnostic rate, laboratory utilization rate, and all charge rates increased significantly during the 5 study years.
- Although all procedure utilization and charge rates in this health plan increased each year, their proportionality consistently was maintained among diagnostically related groups of patients.
By restraining global expenditures, managed health plans conflict with historical utilization and charge patterns. (...)
Mots-clés Pascal : Coût, Santé, Classification, Maladie, Codage, Economie santé, Politique sanitaire, Homme, Etats Unis, Amérique du Nord, Amérique
Mots-clés Pascal anglais : Costs, Health, Classification, Disease, Coding, Health economy, Health policy, Human, United States, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0015136
Code Inist : 002B30A04B. Création : 17/04/1998.