Patients classification System

tools for
Cost management

tools for
Quality management

tools for
HOSPITAL PLANNING

4  Why to choose US

4  implementation

4  ANECDOTE

4  contact

4  Logic

4  diagnoses

4  procedures

4  inpatients

4  outpatients

4  insurance

4  readmissions

4  reoperations

4  complications

4  deaths

4  length of stay

4  day surgery

4  unjustified stays

INPATIENTS COSTS – INTERPRETATION OF RESULTS

If the observed costs are higher than expected, it means that costs might be reduced. But this does not mean that the hospital is not profitable because their revenues depend on the average cost in Switzerland (not only the most economical retained in the benchmark), on the prices obtained with insurers and cantons, and on the cost weights allocated by SwissDRGs.

The interpretation depends on the context. If the costs ratio is higher among stays followed by a potentially avoidable readmission, this give some evidence that the physicians have guessed that those patients were at more at risk of readmission. On the contrary – if the cost ratio is lower – it is of concern, because it may be associated with premature discharges. A high cost ratio for patients placed in nursing homes indicate that it is probably difficult to find a free nursing bed in the region, questioning the organization of the health system in this region.

The separated analysis of unjustified stays and candidates for one day surgery is necessary to compare hospitals. Otherwise, lower costs might possibly be explained by a higher proportion of inappropriate inpatients’ stays.

Observed costs (CO1)                                                                                                              

Expected costs

-   average (CO0)
- minimal (CO0min)

- maximal (CO0max)

 

Expected costs are based on average costs per diagnosis and procedure category among Swiss hospitals with high performances in 2010 (benchmark):
- potentially avoidable readmissions rate ratio (RAR) < 1.2
- iatrogenic complications rate ratio (RCP) < 1.2
- premature deaths rate ratio (RPD) < 1.2
- inpatients costs ratio (RCO) < 1.0

The costs are adjusted for uncompleted stays (transfer, death), complexity (number of SQLape® diagnoses and procedures categories) to avoid perverse financial effects.
Complications are excluded from adjustment. 95% confidence intervals are provided: CO0min et CO0max.

Cost ratio (RCO): observed rate (CO1) / expected rate (CO0).

Statistical significance

A   significantly lower than expected rate (CO1 < CO0min)       
B   not significantly different from CO1 (CO0min < CO1 < CO0max)
C   significantly higher than expected rate (CO1 > CO0max).

© SQLape s.à.r.l. 2014. Last update: 20.05.2014