| abstract |
The likely consumption of health provider resources that are necessary to treat a particular medical patient are estimated within the framework of the existing Federal mandated system that uses Diagnostic Related Groups (DRG's) for setting the amount of payment that a hospital or other health provider will receive from the United States Government for that patient under the Medicare reimbursement system. The amount of payment is made from a calculation using the DRG system, regardless of the actual cost to the health provider. The Federal system results in a wide variation of health care costs occurring within each DRG, resulting from varying degrees of overall sickness among patients that are similarly classified. The present invention works within the DRG system and all of the sub-groups of DRG's including groups of diagnosis codes and individual diagnosis codes. Hidden information is extracted from the same input data that is used by the DRG system, in order to classify each patient into sub-categories of resource consumption, or other outcome variable, within a designated DRG or DRG sub-group. The invention is implemented by a general purpose computer system. |