Case-mix classification of Medicare residents in skilled nursing facilities: resource utilization groups (RUG-T18).
Medicare residents in Skilled Nursing Facilities (SNFs) represent a small but unique population about which little is known. Data collected in a national sample of 2,564 Medicare residents in 38 SNFs were used to derive a resident classification system appropriate for use in a payment system. The classification system, Resource Utilization Groups-Medicare (RUG-T18) explains 55.5% of the per-diem resource cost differences of Medicare SNF residents. No classification system could be derived to provide significant explanation of per-episode costs. Although Medicare residents are admitted to SNFs immediately following an acute stay that is paid according to their diagnosis-related groups, the DRGs were ineffective in explaining SNF resource costs.
Fries
B E
BE
Department of Health Services Management and Policy, University of Michigan, Ann Arbor 48109-2007.
Schneider
D P
DP
Foley
W J
WJ
Dowling
M
M
D002140:California; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003625:Data Collection; D003953:Diagnosis-Related Groups / Q000191:economics*; D005431:Florida; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois; D008134:Long-Term Care / Q000145:classification*; D006278:Medicare / Q000706:statistics & numerical data*; D009518:New York; D010414:Pennsylvania; D012051:Reimbursement Mechanisms; D012866:Skilled Nursing Facilities / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States