Author/Editor		Ceglar, Jakob; Marušič, Dorjan; Mate, Tanja; Turel, Matjaž; Jazbec, Janez; Sojar, Valentin; Hindle, Don; Brcar, Polona; Stare, Janez; Vidmar, Gaj
Title		Inappropriate admissions: element in the reimbursement system
Type		članek
Source		In: Boucher AM, Tinker AK, Hawkins RL, et al, editors. Capitalizing on case mix: gaining a global perspective. Proceedings of the 19th international case mix conference; 2003 Oct 8-11; Washington. Murray: 3M Health information systems,
Publication year		2003
Volume		str. 102-11
Language		eng
Abstract		Until recently, Slovenia used a budget-share output-based funding model where prospective target volumes for inpatient outputs were defmed using days of stay. This encouraged prolongation of lengths of stay. In 2000, outputs were redefmed as complete inpatient episodes using a crude classification of specialties, which was replaced by DRGs in 2003. This change encouraged reductions in lengths of stay but did little to ensure admissions were appropriate. Indeed, there was largely anecdotal evidence that patients were sometimes admitted without good clinical reason merely to ensure the targets were met. Overseas versions of the Appropriateness Evaluation Protocol (AEP) were therefore reviewed and a Slovenian modification developed by expert clinical groups. This instrument was applied to a sample of discharges at all acute care hospitals in the beginning of 2003. It was found that the rate of inappropriate admissions was 5.5%, although there were large variations between hospitals and specialties. For this and other reasons, we suspect that there was a variable degree of underreporting. However, the main objective of the survey - to provide hospitals with first-hand experience of audit methods and create a shared understanding of the seriousness of the problem - were achieved. All parties therefore agreed to the introduction of fmancial penalties for inappropriate admissions for budget year 2003.
Descriptors		PATIENT ADMISSION REIMBURSEMENT MECHANISMS LENGTH OF STAY HOSPITALIZATION DIAGNOSIS-RELATED GROUPS HEALTH POLICY HOSPITAL COSTS SLOVENIA