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Using Existing Case-Mix Methods to Fund Trauma Cases

Monakova, Julia; Blais, Irene; Botz, Charles PhD; Chechulin, Yuriy MD; Picciano, Gino; Basinski, Antoni PhD, MD

¹consultant, Ontario Joint Policy and Planning Committee, and senior project manager, University Health Network, Toronto, Ontario, Canada

²director, Decision Support, The Hospital for Sick Children, Toronto

³manager, Case Costing London Health Sciences Center, London, Ontario, Canada

⁴consultant, Ontario Joint Policy and Planning Committee, and senior methodologist, Ministry of Health and Long-Term Care, Toronto, Ontario, Canada

⁵senior vice president and chief operating officer, The Ottawa Hospital, Ottawa, Ontario, Canada

⁶consultant, Ontario Joint Policy and Planning Committee, and independent statistical consultant, Toronto

For more information on the concepts in this article, please contact Ms. Monakova at [email protected].

Journal of Healthcare Management 55(1):p 51-64, January 2010.

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Abstract

EXECUTIVE SUMMARY

Policymakers frequently face the need to increase funding in isolated and frequently heterogeneous (clinically and in terms of resource consumption) patient subpopulations. This article presents a methodologic solution for testing the appropriateness of using existing grouping and weighting methodologies for funding subsets of patients in the scenario where a case-mix approach is preferable to a flat-rate based payment system. Using as an example the subpopulation of trauma cases of Ontario lead trauma hospitals, the statistical techniques of linear and nonlinear regression models, regression trees, and spline models were applied to examine the fit of the existing case-mix groups and reference weights for the trauma cases.

The analyses demonstrated that for funding Ontario trauma cases, the existing case-mix systems can form the basis for rational and equitable hospital funding, decreasing the need to develop a different grouper for this subset of patients. This study confirmed that Injury Severity Score is a poor predictor of costs for trauma patients. Although our analysis used the Canadian case-mix classification system and cost weights, the demonstrated concept of using existing case-mix systems to develop funding rates for specific subsets of patient populations may be applicable internationally.