Ten issues to consider when evaluating case-mix reimbursement

In a previous article available case-mix measures and their present reimbursement applications were summarized. This article complements that one by describing ten major policy issues faced by payers and hospitals interested in evaluating case-mix reimbursement: choosing the case-mix measure; tying the case-mix measure to reimbursement; determining which costs are case-mix related; allocating costs to diagnostic groups; identifying, collecting and processing the data; defining atypical patients; examining historical trends; deciding which third parties will participate; meeting the needs of different types of hospitals, and designing an exceptions process.