The introduction of casemix into a maternity hospital setting

Item type Report

Authors Kelly, Vanessa

Publisher Department of Health (DoH)

Downloaded 15-Jul-2018 12:18:12

Link to item http://hdl.handle.net/10147/253653

Find this and similar works at - http://www.lenus.ie/hse

TliE INTftOOUCT'lON OF c.ualX INTO A MA TElHrTY HOSPITAL ."" ...

" VANESSA KELlY, ACCA.

-_ ... ---., ... -,,-_.-.... ------........ -"SfOCiOII1c-.;~.-...,. --"

CHAPTER 1; WHAT IS CASEMlX?

1 1 I(IBOQUCJK!t!

c-a ... DoI ........ ~IO ...:ognIM_/'apiaoI.aMIy_

ccmpl""IIy,*, ""'Y~Irom_ /'apiaoIm."..- ..... _

__ .~bt\lQnIntoCCO'lSideralion"a.._cl~

ft,.oIding Since ,003a.. OeI>oortmentclHNllh '*' bMn..u.g."VI*" cl

C ...... ..-...-~ onOilou"'*' RtiI!'*<I ~(ORGo)1O -..... ~ dIN bIdi'Ig alc<:alad 10 IN ...... acuIa hoepitaIo .. _ ThillIPIlfI*:hotOOgtl_lllalpaylngl'ollpitalaonhbollllcl

hIaIorIcc:ootl_not ........ hoepitaIo ... _aqUitIbIy ..... ~ 11 _ ........ __ h~~a..HaIIonaIc-a

Prqac:I .. Juna '"'.

n.. ~ d HtaIh .. IMi' c-nII< ........ _1hat a.. pmcipaI

..... ola..HaIIonaIc-aPnljad ... 1o:

• ·q~~OU!pIA ... WW1_ .. ~IO .. pat\II:Ipat'oII .. IN

1>e~"VI*";

• ~ .. ~...,...,.".Iot~ ... qo.oaMyclpalltnl __ : -

• PuI~~.~clOI.C!lUI __ ",,*,,"'oupporI"

~.udilIuodon~--=-.,..;I"~"

ThiI thMIt_ ... _ionclc-rio:r..o. -..,. ....... ""*'" .,..;I ..... /oIawIng~:

• w.t .......... 1nwIYed in ullnding ea......1nIo • ..-rity

~ MlIIrq? (CMpW 2)

• WhIIt~ ... ~inlhe.'-"'~ HIPEr.tol~

~.(Cilll!*f3)

WhIIt~ ... ~in'!he""""or~COIti'ICIr..o.

-..Ily -*9. (ct.IpW 4)

In~ hoepbI....,In.'""I' .... ~"' .. pricIpInII. '!he o.p.mw.t hid '" cI"WM. ____ ........... .,..;1 _~ or

~1hI~worIdoIdol __ ~. n.... ... """I''''''''' c...u_ ......... ltldlhl_a-by'!heDlptr!nw"ll

1IhIQnI"~""" •• ~ta ON d..ound m ORGI bINd on cIriicII~_UMdl"8lOUfOM.9ygtOl.ll>ing.hoII>ItaII~

...... Wo IhII NI cl mutueIy ucUiv'I DRGlIheIloeplttll WOIidoId C*I be

.....-..a_...."..in.mudI"""'~'""I' c-........ _.......,..,..,..,..;I ..... d_ ... C*I ... """""'*' ....... __ 1IoePI*. ThiI-.ldhl/p ...... "'jlldgehcMb.,..",.._

-....,.,.oI_for~.-trPII~ ...... __ oI ..... -. c-nb ... ovrWdp<:lllllfWlll ..... _."".."...., IInQuIoI b

~1tId~._C*lhllpta ........ ..w:. ... oH&>Id.

~_juttHledby .. """"'*""<I.II.C*I..., ... .-byl\otpilall'"

8I\IIyII~d_own_ItId~ItId • ..,...blll

-ntionfll.........",.LoI~_~"'d8if,~h_ inporIn ... fllc.... ____ ..... LoI .. MIIir9f11 .........

~ . ... llM1f128ho1p/t111l...:1lh11r~ ........ "'~ ...

c.....-.. "*.....-'*'-'"'I~oI .. ~

~In -.d. 11 1110728 tQpbIt-._In ... c-na Pf'X'I"'IhII.....-..wtuIIy-,_IIcJiII>itaI __ ... ~

d~. ~.ohoukIbltl'lOledlhM._ ....... ..",.,."'.-.:I .. c-ra"-"'-ptOOIIUbeyoncI __ hOIpitaI~InQlhet

~ .. oetIingll.Ud1 .. m.tenify 1>otpIIaII. lNI,.... ...................

lIdrlg"'I~In"""''''KI'Iie'I'III.Ud1 ... ''''''''.

1 2 M C KQf!OUNQ IQ re MW!

InIrwilnd .. pt'O'IIWcInol"-- ... io~""""""', o.n.ocIJar

~ ___ "'''_,_""","''''*''',,*!U* -*" .. ...,_ ... oiMouI ......................... '*-"I <=-1I'ICIt ........... II .. ~ ... ~oI ___ ..

~oIc....C8IIbIt_.

In IncMIrt _~ k..-theeooc oI.......-.g Iheir prodoud Ihr<>Jgh e

..... nIgIIMI'II_nc:y prooeu....:l ~ Cln-.n1Ml1he prio&

tMydllrge _1hII "'*' 1I.1httefotI........,... Jarlhe heelth_ ",dolhe_? .. Ihe __ ... _ffomInclullry?CIn ... noc

pnRm~IIle",*oI~Jarenmpil.c-s.cuo..

DIIIwry1_ ............... "' .......... __ In .. __ ...... "'1heir ___ ... 7

..... __ , .lcCoIlhcughI __ .... "*'--..... • ..,....., 1hM."""*I __ .-tiIYllcJill>italmHiIy .1III ..... 1UDCII'*Id1hll

adI'lYI'*"ohoukI_lhe~c:oIIId:

. ~~_~~~ .... ~wiIh"""" ......... 'T'-~_lObe...,~encI~by -

• ~----.-;-~~po!IiIfCI .... ~- ........

~ ... ~~~

• ~1O ..... -__ .Iarge....".., .... cr/J)IIliInIllroopIlO_

It. 1IboYt..........-. .......... ........:Ih 10 be IMfUlIO "*""""'*"

n. .. ..,...,,_"'""�t. _____ ~InIt._ IllOO'1;by ... SchooI"'CIrva'IiMIion....t~.y.~

... ORa.~. ORG. ...... ~lwgWyby ... ~ ~..cIoIIcIIIt~.ooI"IictI .... IorIt.~"'It. ..... _

......... ~"'pott.bIe.,.......IIfaupeIn .. .,.,."._.

VHe 0Ra.1ww~ ~w.c:.II-..III8O"., _!.wcrth noIi1g

IMI """*" ORG ..... _ 'Ill oonIofm 11> It. prIncIpIooo '" cIinIcIoI

1MIri"IQfI*-....t.........,. horncJgM"o8ity.

"" ~ _ ORGo .... 1t. c-nt. _ utiIMd by It.

~"'HMIIII. n-. ..... ....-"'difI..-.nI. .... ~ _1o_tran.I-.yInc:lud.:

• ~ s.-iIy Inda (CS/)

• P.e5n ___ ~~)

• ..... ~~~&t*"n(MEOISGRPS)

• AI;:oM ~ CIwonie ~ E~ (APACHE.)

n..O"--DlHeIIth_ ..... ~ ....... IhIIDRGI_

...... _'-Y_~..--........,.~~ . • good~DI-..... ... _ ..... ~......-DlptIIiInt

~ .. . 1II<UI:j..., • ...-d1hll IN IIICI. ......... ..---...,. ... _IhII~.,., __ .... .-... __ _

lhiI"""*IIIidIN~"'DRG..

1 J CASE.,! COMpoNENTS

n....,.-.-.-~~<I$ ... ORG..hII~

..:IMIy ..,.... '-PbiI. eno. It. actMly <IN ... -. otMIgnId. _ "..,

• ~ to It. c.t. to genwaao. budgM model b It. hoIpbI. 11 . It.

budget model ""I • UNCI to".,."..,. ""'PIIU.

n..principIII_"'tx.piIaI.aMty_b~~ .... ~ ........... Er<I<*Y(HIPE).For __ HlPE ___

~-.~IIay~.~ .... ...:I- ...

~~~""""""'''''~-~ .............. ~codIioIg _ .1CO-f.CM. l'-1CD-8-CM _ .. ~ __ ...... HIPE_ ......... _-.--*' .. IN r-pbIbynr.l_. WOIIUng off IN ctnicIII ~ b_ ptIIiInt.

n..~.nd Pft'C*IIn ""'- ... ...t by IN ~ ~...:I.

-...\OgoICI'oIt'"""' ... odw_~. \INId ... -.ign_ ......... ,.,

.. ~ OOG. E8Ch InpMIenI CUII_1In 10 .u.ignlolllo .....

DflGcrij ~iI __ OII'CQII1IIulillllilOcalalgollhn.lIIirciI'"

..... of~ ....... ~<iIgr<:IaIt.~ ......... ~~._-.ga_ Thit~ _____ "

1IoopDI'.C-*~ .. ORG"""

n.maitw._ORG~iI~_~byo.HMIIhc....

FlNotK:O'Ig ..... ....-- (HCFA)" 0. UniiId S-. HCF ........... 1he

~ ..... uaIy 10_ aocounI ofcNl'IIIM" "*'"* ~...t_ ~ ... n. ~ of HeooIIt! .curr.n~ \IPIg HCF ... -u.n 12

(HCF ... 12). (The .......... ......., ......... HCF ... 8)

n.pMdpIII ..... -*v._IO.ORG_............, ....... .. 1heC-*.........t

"1 ~_~~lOpmwy~InIo""*"'Y ....... ...t ~ ....... DiIgnoIIicc....-(W)CI). n..r._ 25 well CIIIpIeI; .. HCf ... 8 _!hey _ -..:I ~ 011 ~

~or1he -"""Y ........ .,... bu....

2 . ........ the MOC ...... _ b1her ,,*,..:oording 10 ""'*'* Of not.

PfOOId""' .... piWfomIId:-·~opIIt.-~·

3.MIadieII __ ,,*,_~.~loprlndpal

~ lkItgiQII __ '*'!IOf'iMd by1he..-t ..................

~1.-:I""*"iI.-...:IlI01hepmwy<ilgr<:lalt.

4 FinIII'._diIgn<-*or....p-*"""""'_-......OII .. baoiIoflKknlldl_......-y~ . • • COInIIIbId .. or

compbiIIonI. ~ ruamPfOl*hna...t cIIactIIfVI--. ......... 1he~cftt-.~ ... __ lohlvl.

a1gnillclnt-"KC0IIIangthcfot.y.4

~""",".alwil)rd"hofPIIIIlODRGJ."""dlpll" ........". d_IO".--.c 0RG0. e..dIORG II Uf*Hd 10 _. ___ d_~IO...,ohIrORO'"'"""u"

_--..a.n..o._ .... ~._d .............. ......... g 1IIb_.drugiI.-. .......or.gtirMlIIC.~_ ...

~ ptOYkIed IIYo.Igh" ~eo.tJ"ICI PfOO'M. ThiI p!...a

.uig,.,._IO .. ~_willlin .. ""'PbI.II.a..tetrII:.. ()ynMooIoIJy. PMdIelrioo. f ..... puJ>DUI 01 CUembc. clat.llllMen fn:m

.. 1niIW IIIiQI oIlhi1....-...g ~ rod thin '-10_1" Ma.. Tt-.

ORG ... be • Id oI.aMty bekIw h :sp.;iII:y IMI.

Tt-.~....-...g.,.-" iderdiM.. ""'-da.t"'- . ·11

~.~~. ""--. o.t..y .... In~tt. ---,.__.-.:iM.-wlbe ..;gn.I1o_OOII _ . _

_ ......... ~IO .. ORG_." .. c...nIII ....... ",.,. ....

IIIIoceIIdIO .. DRG ..... onlhll_of • ..col ·ORG ......... ~· ...

.. ·~_·._ ..... luncIionof.,.lwiIJIhol~. CoI._<;>:dcI

be ~ on .. _ oIORG ....w.-va. Include dI\I; ......

1IIbDIatory_. __ ~..-.d~COI1eIor...-mplll

~ be MIlgned .... .s.iIy COlI belli.

Tt-.1lftG ......... -..IgID· in ... ~ .... ~by .. Sta!eol

"'-YIInd. USA""' .... ~.........,. . .,....,....., ..... _oI

......... ." ... ~_of~--"-.~~ ThougII

... _d ....... ...,.....,~IrwIIf"d_ .. USA . ...

-....pCIon1l""*"- ..... ~oI.......,. ... _ORGIoII~

...... Tt-.~d ....... _tlwttt.il~-"lnlhil_

~IhiI-....pCIon_ ...... lt pOUtil ..... _.....w:.~ ... .. ~lntirMto_ .. IfIoh.~.

~..tin-.I_ pw DRG_ DRG CM t.. ~ .............

(RV). no. RV ... --*"" 01 ... __ .... 01. '*""""' DRG

......... 1O ... -. .... oI .. ~~TheRViI .. COIIoI

.DRGdlwideclby"'-'COIIoI"ORG&._~ORO"'-" ~.RV"'~_oI_haIpbI __ ..... t..~

i'I.-Hwo _ by CIb.IIIIinQ. ~ -.. (CM!). The hoIpiWI CM!

.....,. t..~ ~ .... _"""'"- 01 !hi c-nb:u..cI

bylhll"'-Plllllnllimpll_.c.nt...~.IcIawIo:

s.m q!FIIII_QBG I RYq!'bM QBG

Allalf>blwiII.CNloI ..... -..kI_.c..nbI~IO ... -.

COIIblll_for .. ~IO_.llbe1nu~. ACMI_

11.- .......... ~_IhIe...-u..cI by 1JW1IoIpbI._

~ ...... IOIJW-...-.I........, .. ....--.....

TheCNI ...... I.IMdIO.....-IJWe...-~_I* ..... ThiI.

1oW"rIpIy .......... COlI 1*"" .t;.o.IId b ... haIpbICMI. Thee...-

~ OC-I 1* ...... mono ooptIiItieaIed OC-I for ~ IM"POMI

'**"" M,...IJW d",.....,.. i'I_~ ~ hoIp/IlI.1nIo

""""'-""iI1WJ d""""'" i'I!hI ~ COlI pw"'" "'" now no IofIQef t..

......,.~IO~In"...~

.,. ...... 1hI ~ ~ ~ by'" o.pom.nt:oIHM1h __

IhItllwllguNeCllb.lllllecl""""lhItoI:MMo~ .. _IO""'-"

haI!*II budgIt for!hl.,.... CUrrInI:tJ IS'1o(*"*'u IIM)oI .. t-..piIIIolrt­

~_"~UliflClllwtol:MMo"""""; wiII8&'1oolt.o.pobll

"""_lTIIkrOup"' __ · ThiI~wiII,~""0I5'" 1n11lll3(11w""",for_""~)

1.1 UHA Of CAUW}!

. ~I>JdOIIMIIi'II

. Strlleglc~~ .

• lOC8l~by~

T~ .. o.s--"'''''MI~~by~_ ~ __ ~"""'-Ior""'-".~_ n:r-IIIC.. Thltltobvioullly.~of"""""bullUIIIoI ' '''

~_""~_OI*I"'.aNII)'_, ""'''''1IIC.. _1n'.31or ....... _c-ra ___ UMdIn .. N'*'CIof

1'IoI!lbI~ ThiI~_""*Fv .... hoapbI'. ___ ~ __ .I\tYiIg_Ior ...... oIpak(IYI*, _

m.ka~1hM~. F ... ......-c>IeIn'lI93lt<e'*<*'IIoI .. -.coat of.~gfO\lPoI""-P __ nlnetylt<eplO"_ofMdlI>otpilal' • .....,

-. coat _ UMd In aok:Uotirol! .. c-ra budII"'''''''-' ThiI bItnd ... _~~ ... l'IIIMnpef_In,_.

1l11ho1*!~..-. ....... c-nu~ltcloo-.ln.budgoII _

_ . __ ~ .... ~ •• _oIc-nbdollO .....

..... of ......... ~ .........

Tha OtpamwItof .... '-__ .. poIcydlcltlon"' ... ~

In .. aIocIIIIon~(dooaahd .... )It.,..,'''bOft1lOlng~

"'tqUity_~lnbc\Mlll'V'witht.o.pbll. Tha ............

...... 1IOtp/IIII~"'OUCpUI ..... CtMIed._~IIIIn_ ...........

of"""" .......... dtIN_]tII1ify .. .....-1III)' proWIa. ThllIIhoI*!

............... ~~~~ ........ ..., lht~oI_.ill"o:II*I_h~-...~ _ __ """-~_ t.1aIlIMd"" ____ o:r:IOM __

_ ~ . .. Iht_~_lhtplllilnl"""_'"

........... _IftC2ice.

The c..nIIt PfOO'U"-' ht ___ hMl_1nfomwbon

aveIIIbII to '*". ThIt ha atMouo ~ III ...... oI...--glng 1he

hoIpIUII'" .n .,....".,..., MIodMt,..".... AI P!M«It ""'''I' hoIpiaoll ....

~wIIhIn....."lIghl"""""'ccor.tnolntootld ...... _~1<now ~_ ........ _ .... goenonIId.in",,",,_.III1Q1~1o

~ ItiI; iNDrmItion II!JOng ~ .-.cI1hnlcn &air! ffan 1he

~oIQIIW"'-PiI*.I'rb"IoIht~ort.C."'"

............. -_ ........................ --.",..-pnodifM. _ ........... ~ The~ or c--b: IIhcdd ....,...,...,...Io~ __ ~ ...............

opentiMln IInN or ..... 11 1IIppenFog_.

C..-rQ .. ~cIinic-*~III!heco.ting~ _ _

"""'OMU. .... ~ by ~ IhiI '*IoN! help lilt. PI'II*

~of"""""_.I""*1Y~ ......... _ittkIlnpuI

1mot.~prtl(*Moandlhenoil~~ _ cInIdIn _ ~!he LooIn;MIur:tion orc-nbo: .... 1he

chdInil"*llht~~Mha"_a...d_c-...

'*I..:t_ ........ ....-.;P'*II ... ""_ ... ~~1he cInIdIn ...... ~ ........ _ '*I t..- _. __ d

~ .... ~. byQIIW~"..,.... n..II .....

........ !heclnldln ... Io<::I..-In~6Iopihon""""'*'"jIIXIioe __ .... t.orllP'dlll~ ... him.

"

~. c....a","""lDOIb~1r"IndIInptldlOt_.

l'Ul'lbwol~ R--....~oI1he~oI_ . ..... 1IQ

.... b .. ....--. oI--"'lnprKb. K '* bMtI q....:I "* Ht o:dd ...... OI*' up .. -tb ....... 01 ___ . c-rD

.,..... ........ _ ...... i'lIN-...rrMItol .. ~oI_.11I

~~II:>_lNquaMyol_wIIhoI.(~ .....

~ ... ~d_lnlllolpnMolonol_.

1 I! CQfIICIIJ'IQN

,.,.,......,.,...,I\ahIdINWrodu<:tionolc-nb<~In:wn ... _

1hll1apitII~ .... baaed ~an IiIIIiI!aIInfDImation II'ICI

..... did notllddt.- any __ '" ~ In ... .,........ ""

.quIIa-trIn"'c-rD~"'''''~''*t\dI __ ...:I ~_bMtI~. "-1hec-.a

~.""' ___ "'_wilIIllWm.. '* bMtI Nid "* ...

~on" ......... ___ oI"'c-.aPf1'laCt"'~on "'~""'~oI ... prtljldln"'IoIoofoing_ ·

• "'C<IIlIirokoIJ~lItIdvaidationol1he~.""IIm'"

......... Ihel M III PfI'I*Iy c.iIor1<l Ul1he ...... oI1he I"",, hotpbI...-.IoM •

• The~oI .. c....a~k'IID __ t\dI_ ......

p!arrioog...:l q...-,.

.1I/IoIAcI ..... be .-.:llhll", c.p.nm.nI oI_III....-..,.1rI¥IIMd i'I

............. ...cl--...oI ... ~II'IDdII. III11...agnioed"*l.

--.."' ..... and _lii0i mocIIil""""......,. '111110 lundIonaflKliwly ~ -. .... _. rarqe oI~ ..... 1he PR'iod .... fIm lNIiMId and, ~of .... n....e _1Ii;hIg_ bfurtlw ........ The

"

-.Ion 01 ... c-ra ............ _ -. oud'IM..-nly....,.....,

....................... _ .. ccpewilhrnuct.mcn .......... ...., ___ ... _ .. ~ ............ n..body.,. ............. ..

--*,-""'''Ir*'>dudIiofI'''''' C-*"- mighI bMt ~~ ~ • ...-niIyIlolpit:ol""*"' ........ a:.ty~ .... mighltMo

~~ ... ~

"

Chaptet 2: What a"" the isa~ Involvtd In axtlndlnll CaHITII. Into a Ma!amity Ho.p~1 SettlrISI?

? ! OVERVIEW Of CHAPTER

no.<;:I\apW ........ "'lNo.-. ___ ............. INC-*

'YI*" 1nI<>.",.twnity hoej)iIalMlWog. ~/Irat _IIIN ~ ofORG to •

.... wniIy h<MpUI MItitv: ~ tt>en C<)I'ISidoIts !he eppIcIIion of !he C-*

...... _~. FiMIr. ~ Ioob "' .... ..........,Ing h CUNI'It coding - . U cQIrtCr" Of CU,fMIX

c........-... _dIIIn.cI .. _--......oI .. ~ ""Y~.WW1._l*!I'Ibh~oI_,_ .............. _<kR'OlhIlIIy. 'Mw! c-ri:< 1I.....-""""'-IO __

~(_kllb~hoI!.pitIIII~ I..-..Q, 3 ....... -...y;

n.. ~ .... ","",!Mo placed ~ ..... by lhIclllltillaltIon.\'WIII n.._n'IUII!Mor;-..-....IghI_~IhI~~

..-...IOCIIhIt ...... of_ n..1ye*" n'IUIIlM/gn ftdipIIotI_.,.,.,.., _ ........ 10

~ptIoM.\

n..""""""oIc......_" ... ___ ~1O ___ II;..t ..... ~"' .. ~~oI ...

............. _1hI!ypMoI_a.t'*'!Mo~" ... 1'\'CII'III'(

.......... AI.IIOd!II ....... ~~donol_."""*c:tllqwIO_

...,_Inco.Irf.cI"~~_"" __ II...., All ~of ___ ~~_MIvIoI~iNdI

irw¥it1b1\1lO~ • .-.ing""""....-.cy ................ wiIh

whk:to....:.ney.'*III ........ In_ .. ."...,.,ICIInWocIuf;>ec-nDc

.-..-_~~I>'I' .. _ICI~~~1n _uIIIiIMIon.~ICI ................... Ior .. _ ...... oI

q,w, c-.. ...... _ICI_-..-~!IOIIpbII.In ...... oear.;. ..... lCIb!>IIIn ... -..-In_at

A} ~nhoopilal_Pf.cticeI

B) 0iIIet..- n hoIpitaIo c...-C) ~~frc.on"""""oIhotpb1_Pf.cticeI_

~

1n""*lCIdo .... ~ ......... lCIboI_. T"Iw~oIbc*1 .-- ....... _____ ..... ~oI • .,.-..b' ~c-ra •• ~~ ..... ~.lIIIII'DIfcl ~ IIIOII.-_~. ' .1. DRGI. N'N;tfi. N, MEOISGRPS.

DlSEASESTAGEINQ "'_in~ ' . DRa. .... -=-:IlI'IICh:ldol

d8NiIkaIion In ....-.I.

23!Ht Cl AlIIFI!rt.tJION SYSTEI!!

_ ......... ~..tyon~ImiIedda\flICl..."...pMina

inIl.lmlleclrunberclCllMgOl:ies.hey .. ~~.hc.e

_. n.u.~.""'~_Inprh::ipla.ICI~""""",,"-*aIion

~ ... <=-a ........... ~bylocJldng.irIdMdI.IIII_. Tha

-"""""' ___ cI-...::y. wt.IIw .. pMitfa In .. ORQ n_ /IoapbI_ .. ____ ~.dopMilllnlllnlhat

DRG~InIlllw"IIoopilMo.Sinoo_il..wIon~ __ ....

__ -~ ........... in.DRGIn.I"IoIpiUIICllltrit

nped",~"""" ..... _~b''''DRG _ .. ......-oI_iJ~

". ___ .... ......-oI_~..,-.._ 1hll000aud ...... ~_ot_ ... bIIo/Iy<lllc:ulNdbeloor . -.. Tht~I_s.-ity~~_~~

wiIh ... ~oI~~morbIrtqo_rnott.Iity_

b'quMlyc:ornl_ TNt .... ~~_--"Iy ~~_~ ...... k'IIo_ot""'~ 1I'QUPJ ....... __ oI~ ......... ~lomlM ........ _ .

TI'III ....... In .. v.y..ty __ oI~_ • .--....

.-.

CSI_~_._oI~lMdill\Wltyol.-r.g.

~"'~.oIlh. ""-Ing_oI"'_oI""""""oIhIIt1w

d ...... Tht~otCSl.IM~oI.""'Ir;toIInde>:.

_'*''''.-iyI!)plied'''~gn;lUptloIpMIna._ ... ,-In_ot-'Y"ot_

c. APACHE.

APACHE_~"''''''~'''''''''''oIq1'*\1ot

mIdIc:>II ... In ................. "..~_APACHEII _ t.kp/lylicqlc~,., IIIffIoIy ~ prugnoMic.ty

~,., ... clcINlh . P ........ ~.~ __ .... 1hII

__ cl~QOImIOIIIy,.....,.~_. APACHE llhu

"-'--...r_on .................. bl..-r'CICon_ ~_~ .... r'CIC"-'-.I ... ~Pf'ldi*rol_

A .o.Idyol ................ -..,..... by ~AI/Ictd_

zm..m..(The~oIMic:hlgM..l_)......, __ oI""

~.~ .......... f*1om'IIId .. _ .. DRGt In _oIpttdicUon

oI~UM.

AtlUC!yolhotpltlll~lnlltlgkmkuld8lt61ht1.,.,.~powwol

DRGt_ """"" botIIw ...... ....,_mIIhod. ... ,.. ...... oI ... lIUdy _

_ ~. PYbIc ..... _'**"'~ ...... 1Ii"

--.uianol_...-.otIII ........ _be~~

oonoIIIemg c-.. ........

_ ..... '-"-'"...",.~~In .... _oIORGa. ~ _ -..y __ ... mtIIhod oIhoIpit:oI NimtIutMrnInl. To _.PfI*It ........... _ ....................... ....-oI

!I'OIIPI ........ be_ICI_ ... pritnlptIIlUIIItIon . .... ....-illDO

.......... gf"OUP'''' "'" be ouIIIoienIIy ...... to'*""-In-'"

~tncI',.. ............ iltoolqo,lhell""'P'wllbe~ ~. A ...... __ tobeItruck.AlluClyol218.000~

cIiIcI\trged ffom . S IMryIMd """"""" In li761T7 kuldlhtl383groupe_ too

_.~"'_ .......... lnoon\rul.ttudyol79.000~

ditchtfVtd fnIm-.. ~ ........ In lt75canc11.Q1d IhtIIIIt

~ ..... "'~<:OI*Ibe~'1hI""-oIORGt ...

~ IrIomWion frcm _.linty """"""".uggoeoIIIMt,,...,,,. DRGt <:OI*Ibe~**-Ihty.....-,." .... ~, __

.............. DRGt".."~.....- .... pttitnllhy"..,, . be...:ltdlCl

c.pIIn ... ~-...ORGIIn .................. F ...... _'"

~_1hI""",*"._"'" iI "'"""'" DRGtwilhkl1ht <UNt1I'~ICI -..eeIy CIIPIuN the InIrIcKiu 01 1ht IriII1 -...y hoIpit:oI. TNt lid _

~ In"""'-c-nlx.,...... AuoInIIo _ .. _c-nio: ..,....,_~. bo.I_ .. ~~n.y __ .. __

"" '*-ioIwdlrl"--*'VY n.y ...... ~0Aa."'~ ___ ~"""'pnMlieb"""""''''''''''ol--=

peIIorD .... _.,.,...arp.~ 1!Qded.~ 1 •• iII

ol_~b."""",""""'olDfla..""*,, .. -""

~oIHMiIh halcIt---. up_ ~ mrybol ~ "" ... o.p.trIWIIoI .....,.. ...... IO"".,..,..lhiI __ tlr'ldconsiclw~ ............ toOiAIon"'lhiI

~ ........ tolhtl....,~

E-. ... ORG..,....,.~OI_ .. ...."... ......... oIORGa • • 1I ~_ ..... ..-.. ~"'_~lI8yI;lOptO'IIii:Ie

_ ...... b .. ~-.ypriof"'--......OI ..... ~_IO ptO'IIii:Ie __ .....-.In........,~ .. ~IO_.-_ tII\ciwIIIy_~_lf .. ORG..,....,ItN;lll..".".. . • .,.,..jd..-

~~"' ___ or.....,;,j--"'c:IIoI.-ol~ .....

~~_s..:h~-*lboIh-..pt .. hMllllcw. -vawn.,., .... __ boIrrier1"' __ ol'***'~N;lII ..

lmIonIIonol"'~"""",

Thecrklc:.lq...tloroln-....irog ......... ol.~IJY8*1I .

~~"., ........ _OII1ICIUII~whol\Ml .... hlgherOl __ ~It.n .. ...tic:IMI-.""_ORG.T..aq

nI SpKiIIiIyIlDljllllll (sudla'- RotmdI)can ....,~1h8I1h11i1 ~_~~The ..... iI~ __ ~ -....Itb .. ~_ .. ---...In_~ ...... ORa • ...a. • ...-....... ~ .... N;lIIboIpIid-oinQ'" ___ .....-.1Nl iI_ .. oIIooIao.- __ ..

-....s.~"'_. n.-....s._.vwtIlillindi¥loP"l*"ll

~1I*IWv_oIiII-.), ....",_N;lIIboIlI"IMI:hedbybolh ol'IIW _ two DubIr! ..-nity "'-PbIL

ThlNwoukI~~ .. otMcuo""......., ..... ~ hoIpbI-..t noC~~~b"' __ ~"'bl*ionl ....... 1WI11 .. -. ....... hM bMn kIw*IIed • ....tiro; ~ by HCf .... H 11

..... ~ID"'*hllhe_ .... ~""'*""...~

~~ by.Wlliglltingp!O(*l ............. doMnoI"""""""~

..r.ct1he d,,*-~ -. ThiI p!O(*I .... lIo.t.iIId In IMCIi<>'I 2.<1 -. ThIN '- ...., bMtI ""......., .....-cl 1bouI .. .,...... .-... Ill-. __ .... 'ORGCtMp·. ThiI_ID .. ~oocIIn; ....

.-,r,dIiIp'IOIitlD _ ----.c. en. -*'tIiI"'1he~

.&d .... ~'/oI.rv:I ___ In. CeIbnIIo hoIpbIc:o<*' _

_ lncr-.Iby~~I"~_~_

....- ID ...... ~Inc:crnoo. nw. .... lbbChI '*PitIII cauId

~MkIiIiDnaIlnc:crnooby·~·. _""'"_I."""'lDputln

pile. ~ ID 111.d11he ~ ",a.-. AI ~1he ESRI pn.rm opal

'*- on "cilia. bill In OftI«lDgNe gNMat~1D Ill-. ')'Wm. ~ """"" be Ih'OI'\hwhIIII pWin; In plle.1IIDf'II fDrmaI. detalad .nd .tru::IUNd '*­on !ha...moll coding '\'1*1'. 1WI-..t ..... IwWIIIw addtd .,;!vII .... of

inauI.Ing the~ ......... ayown.

Tocanc:locl.IhiIMdian .• ltln'f)Dlllrllt:l~tf*.ilnoC~1O ...,.,.....~..,........_ .... ~alOAGl_cIIIMiIIcaIion .,-.. __ ""..It~_~InIonneIIan~on"""

..IIoIc:b ... In ..... '"'*""E--.g .. ~ .. _oIho1pit11 _ ...... __ WOIkIt ......... _NgMI ... DROa .... IoIowInII_

"ThelllCoI ___ ~_noI~ICI"IoIDC'.

1n-.hictl"-Y_~ ____ VIIIdIoIId '"-__

...... 2. c..t.In_Illlhich_~"-In_~ __

... _-",,*~ICI_DRa._oI ...

-..npbon IMt • peCiIrIt ahoUd noI fIIdI tt. -.. DRGIrom !WO

-<>C. 3. n..~oI~~ICeOfd~to~.proced ....

fIIhIr IhIn ~ .-la 10 be ."~'IOf.'tln _ wr.we • major

~Pf'II*I .... """"1O.~diogno.la'""'-tIwl.

PI'In*'f~ ..•

~_~1O~ ....... 1dtr6:aI~ .. "

0.. mulllIiIo con.IcIw .. 1Ia .. ORG. """ look 11 ~ dwIly /In

.......... c/IIIMiIIcaIIoIay-...~b~. n._1O ..

01'0 ..... ,.... noI,..._ iIound (........., IlllCluc*lIrom .. c-n/:I<lI"IOdIII) •

."...,. obNor-.o ...... _ ......... __ coo;Iftg oyawn....,be~ . ..

ICO-8-CM cIoM noI......-y -.:.tIe .. 0UIpIIiInC dwIly Tt-. ~ 01 .

~ fY'*Il oI~b OPO{....:I"I .. R...owould ctM:luIIy noI be

MIde.ltiIUIdofoln .... oI~_lrIiIrWIogflq....-.

"'@4ntt. ..... oIl11.W:1_~.w!lichkllnlillld ... ~oItt.DRG

~ ...... 1O_ .......... ~~wilhhllla_1hia

..,..,..oIc-ra_w!lich,...._o.-d .... bealafor~ _.nIIionII~ ____ In ... l..II"*dsr-alnce'!i83.~_

dIocidItdlClpt-.cl_._"' .. ORG--.,..onllllhdllll. n.._ lCIpt-.clwiIh .. ___ --'"<IIIy .......... oI~

~on ... ~"'INogrIIWogc:...... __ __ 1O_ ......... ___ 1n ... 1apaI~ ..

Y THE GROUP l !RueDlRF FQR CASEIQ, .m&IITWNTI

Thec-nb: bucIg-.~_ Wrnduoed In IreIInd In 1D113. II-.-.

1'_1'IOIpbIo~. 1n11111726~_1r...-1n~Pf'X*a,

IhII~WtuaIy"~wilnln .. _of5,OOO~. ~.

~1hM~1II.d'I .. 1eachIng~~~""lhetypMof

~trMtedln.l'IOIpit:IIllndh.......-..:t<ilma'ldtonholpltll_.

In ~1IO dNI .... 1I-. ",*"". Ihe 1IoIIDIo ....... ~c....... projId

_ ~ doIII\'t.ndIId KIOIIfdirogllO---. --. 1Nl ~ In~

"'-of_~of~ TheGruupAhDIpUIo .. ~ t.o.pbiI

""*"....,.lIII*IIYbI~lIO_ ..... ---. ............. ""*- Gruup B ~"naII""-lIO_"""""'---' __ ,." ......... __ oI ... _c.......~In..-nily

........... IhI~ItndInIcrSl.dl ........ _~~Ihet"'*onh

....-lIObucIOIt.....,...",.

The .. 1mItion of,..,. en.nb< budgeI ~ •• a:wrc>II' 0lIl and In orOef

\oll*fllPlQCilltellwlig~of,..,."'-PbI~.lhebudClltacljultmenl

~.MlO\.CIn<letall_

o-..on~~.~ InIhaIlPe 'YIIIm. Tt. PflICIIU by""*" ... _._ ...... InChliptlrl.

,."~"""*' .... ,,.,...O\.Con ... __ .~by

~HIPE.,......lNoP'""'**..-.-_ .. _ .. ~

~_Ihe~.~beIow F .... lIIIIjortyof

1'IOIpit:II~ "-Pf'X*a.--*"I'~;

"--. ~patianta.....,_ ... --....IhaC.dihrenl

lrom"'whdI-*I __ ~b"oondiIionOlpt'Clbllrn

~""". "*....,._lhat..,...~'-.",,,,*OI""-1IWp .................... ____ b .. ......,.o�~

~.-Ib ... -pt'CIbIIrn.AI ....... fIIDIOO"IIIiMoIllrlgllflf 1Iay .... ~onho&pilal_oolio __ lhat _

_ ... fM1y~lOIin-..q ... ~budgM.1n

~to~tnioabjeor::liV& .•• ---..ytotrllflf .. dd'MIlha boInI .... bayond which II-..~ _ ... Iourd. In ~

_tnio_lIII4Ir*lghloorcllholllayll1mpolnllb~1

_ .. tl-..ymay .... in-=hORG. FOI-=hDRGhlrimpe*lll ..

Mwd"IM·~~~d"""'3~~··. ,,* ___ in . DRG""'liIo"IiIhflflla)'lhat_bayond

........ hlGhOl .. lIMlI1mpe*lll .......... ID ... ~_

TO/I'IiMIiM ... -....lhatmay ... QUMdlDlanglloIlAy dIIIrIbIAIonby _____ .... dIIIII .. .....,....OId1nd

_____ lwQIIIflfllay ............. 01'" nn ..........

MoIIgrIed"'''''lIIholllayflfh~lI1mpoh.

3. FoIIc/wWIg thIo PfOC*IIn .• ryHom .. appIiIod 101 ... _ 0I1OCIClIIdini

.. diIcNtgM. ceoe ..... ~ ID ~OI nallhay can be

~lDbef"Olllir-.diKIIargn. in~_IhIa_

-.q lhalhonoaylnd 1orog1lay·""""'_.tog&ItwrwiCh ...

MIimadonollllAl~~IJI"'~""'" n. ".,...,...oI.,. .. oI ... ~.ID_ ... ooc.-.llllOll IIay __ 1OI"4jI1Ay_"ICCOIdId~cndiI""'''

--.101 ........ _. "FOI-=h DRG 1lIOII lAy _Iorog lAy _ .. <WIr..s ____ ~ ................ oI ... ~-

IangIIflflAy . l-ll111_ .......... (SO) ... ~-.u ........ ___ flflha~ ___ oIt1&y·l.l.1111

_~ .. DDnIidI&radlDbe ...... _""' .. &Migned

._ ..... 011 Statotay ........... .--oeIIrIId."-_

""*"1wGIII"'1Iay·_ .......... ~poftI(L-.1M

~_IIngIhol'IIay ..... , .III!JSO~The_ ..... lottueh oo.dItIc ................ _"' .. _...��tv't�oI'IIayIot .. _

IIMIIedby .. _"""""'IIayIot ... ORO . ..-d ... be ....... _ .... , ~iI:JrIOlIay_ .... __ ""*,,IIngIhol'1Iay

........ _lMhIgh~poW:p.. ... ~_IIrQ'tI'"

• .,.pg1I11!JSO). n-_ .... ~"'w.nw1I.v ..... ., _oI'._1hey .. -...a", ....... lIddi1ionlldemandlcn ...

_<l ... ~.TodlllomWll~~ ...... d ... lO.iI:JrIO

"*Y_ ... ......-<l~bIy<:nd ... ~poftI .. 1IMIIed

by 1M_""9fIoI' lily lot ... ORO..-d"..",..... by • ....pad .... Intoelcli1lcnlO"WIIIgIDlg-"'*'_. __ _

~out", ... hoIpitII .... ""'...-.dIO __ '" ~~_~. I'A ___ aut .. ",,"*

.................. _ ...... <11 .

s. The _ WonnI1Ion • tuppIiad by IM ~ CoMIng lytIIm. The

~by_1hiI1nbmrion.tuppIiad • .......,.,CIIIpIef •. 11. The ... .,.wg.., ... _.lo<*k:ullll1hl~C-Mblfndu

(CMI). TheCMI( .. ,.".,...,IO .. ~').IhII ........ ~oI

"'c-nb<.-Iby .. t.c:.pbt.ACMI_.~""'~ _ .. c:.-b<_by .. hoIpitII ........ ~ ...... lo ...

-...-d ... _~In........, .. CMI.~ .. --> AI~_hoIpitIIKIIwItr.~IO·ORG.

b) HoapUIDDIt1I ......... ~IO.ORG~ai1ha<

~,.,..;gtaorD1t.-_ .... (~InChapW.).

cl UI*Ig o._"""fV.no III -. COIII*ORG iI

~(\.oI. COIIor~ ............. orORG)

d) "' ............ (RV)""_DRGiI~~.O'

-.COIIoro.-..ORGlIMdIedbyhIOlllCOll .. -.) ThI""'IIIIQI~o.mulllplclllanoro.R\I""_

DRGby the......wor_In_OAO.

ThI ..... or .. theCllc:lMllotllfl poO'It.)_illaIc",.nd dMdod by the _ ........... et _ . ThiI iI thlllIoIpUi

'M' ThlCMliletIIII:lIIIOO' __ ....... b"IIlY~in ...

~~~n...:n ......... CCIC~orlllY 8""'Por'-"'* .... ~.--<:WIbe....,~by~

_-.COIIby_CMl .

...... __ ...... 0. CM! "'" bIltI'*<:uIMld •• _IO~

0. c.-ra MjuAld _1* .... ~Iy ~ iI!he ...... -'

1* _dMded by !he CM). n. CMIIl'ibc ICI/UlI8d coet 1*_11. _~~..-.... oIlhe_oIl1oef1b1lC1M1y

~wiIII!heauclol_oI .... _PI'"_. ThiliI _. ___ • __ or ... ~ oIlIw'-Pbllnll ttw

__ In c-raollhl hoIc:UL

8. .....hc-na~_pef ... ~._or~ IIoIIpbIDDlllIO_ .. ....,.be~.~or .......

~.n...:nin .. _af~ ........ 1IOIIfIIIII ~ .... c-.w...-_pef_"" __ ~ ......., be_IO .... ..a.- fDrllwgrOUp'" wIIoII. ThI

OIp.I_or ..... <:WIIhereIorI-.diuII .... ~oI..,..."'-PitIiI

~on"."","", __ )",,,,,",_al"''''''''''in'''

c...-.......... ~ ..... ~in~ ............ .m ~-.....in ... ....,....,.,, __ "'.hoIpUI..., __ ~",.hoIpUI,.~ __ .-*'I*Id. TNt __ only ..... .,...,...,,~ t-..pbIo III.d\III ~.~Io __ allI"IIoc...a ............ ~

_. N.~l5%alhoIpUI~_ .. ~framll"llo

_ctIoua.tion. K.~Io_"IiI.InIhll"~

pnICMI. dotioI in • "b\IdgeI '*'"'" w.y "'. IhoH ~ IhII ~ fram ~ ~ pnlCMlOoIlO" ~ ___ alOIhtrhoej)bllwl!hln

li"ii0,,,,,,,, .•• ...,inIporIanIIo .......................... ,............l ..

• -.... tIIIo ,.., •• Nodo.donlo'" _-.Ion lotiN_-,.. .

• eM--... .. ....., _ ...... groupir"4J ....... Il0-.l eM.m ... _. oIgniIIcM impId on ... tuIgM........,c ~ n. ~ aI.II""'PPIb.I'""-"*I"'/IdIU1IIo~_allmpro<4cI~ _1IoopDIo.nd. """" ____ "'_'*-''---.......... grvup. ThiI .... onIy __ ... '---_iNlI""'P ... ~ .... IO ....... ~.lnhprftMl_, II»RotlnII

HoIpbI-.okI nor "'" InIo _ 0111» exiltiog ~ 1I -.ok11wrekn ..

_rylO_e.-~wiIh ... _~~hoepiIell._ .~ .. """"-.onebIe.m'_irlo~1hoM~1O __

_ IOII»~ '---_ .... ayoiIm.

2 • Ill! cttD!CI Of CO!!!tG SOflWMI OCR' GM)

"c-nIo~lIhouIdl"llliolbly"dIaify .... __ inll» __ _

__ .~t>,dl\Innt~ . ............ aI~t>,.

cInicIwl.mcoclinD ... ~t>,..,~"""*-~ ~1n~ ... princlpIII~. TNt ..... lodlec:uNed In

.... In CIwpW . _ 'IIIQUId oppIy.,...,'" -...,..:1 AI;:oM 1IoIpbIIII. n. _"")udgII.-~InIlllll~""'<IognoIII_~ _ ......... ""~1n1rn7. n.ylllUlliodcoilnl ..... 1IIIII

__ ~""~ ___ ..... InIlllllIJriillld~.

EIghIh ~ (lCO-8) • ..:I b,wIllllUlS1n1lilty pe!-.! ",,_In _ ..

..... I*QIIII "" ___ """-*I nat """" on "'" COfNd coiInI 'MIll" cun.nt d~nooIIc.,....., (!cD""') iI_III'l"'fIC""" coding ~Md

_orideIy""-<l; ........ of~~ ........ n.~

~oI .... Ith_CCITIbined.~ .. loI ........ wt.e ~ c.It-.old _In ..aIgmw'II"'~ ORa.. n. • .,..uy becaoM~ ___ caoroatbe...,~ ..... ..,.coding

_ .'-._ ..... t..I~ ... ~ .. _ ..........

_coiInI~"'....-r.I~ ...... _"''*­inIuiIIon. "*iI....-.. _wIIk:t!.--_~_ upgtd\g "' .... _wiII--..-In.....:bl~.

en.pr-.. __ ... _._ __ ""' .............. oIl11111cun.nt

coding _ . Son. cm. ... be.digiI cm. ....... ~ ... _e.. cIIg ... T_""'~oI"CIorf\lip·whoINoodIt .. 7..a.1._.fifthdigil

"... be _10 opKlty "'" .uc:t1ypoo oI"CIellIip' ... .....p. 74Q.11 ."CIeft lip

- .......... compIeIe; •. The llfth dlgi: ....... ""'code_ptKiM To"'"

~1hiId.1irdic:wo!l'lll;llnalbefuly~end--...~

...... '" tIoIo.-t41noir*1Q 1ot .. <:OdM _dNrptlll*lne....-r.l",

... QXIers. The ROII.o'IdIIIYJI,pUI t... on.. 14' • doo.r'rId caIld "Cai"Ijj &

c-nb: GooIdeInM' In .. -.", ........,.. .. ptObIIm. A copy "" 1hiI

_.Inc:*.oct.d.~2.Iu.-."''''beimpollwt'''prooIcIe

"'-'1D1lllllc-._ ......... 1hei'~on ....... bIoeiL

n.~~_oIMaueIydonal ..... _""QtInIrv ~ftoom~. CW::Ien~.atIIceIlfh RoturdI.",

........uyWrod""' .. c-... .,.....,_ ....... ~1OOI.

,.. ..... ~Chopwl . • c-nb:.,....,_t.~~lto.

~oI ...... lnIo~ .... ..- .... -. __ ~_

1Ot.~by~Chopw301 __ ''''''''''''''d

ooc1itIg~ ... _.a..ty_ht~~II __ IO'"

...no..~. c-.,. .. ~ ... t. ... _IIitIcul""'oItM

....-,...,...,....~,~ iI~/oIIfIOMY'*1I01Ong_~

"i1'Ier~lhIIir~r.oOD<lingsyoanwlbe"'IO_Iof_"

-,,~.

2 , CQlWUN!C.t.'T!OtnUPPQ8T FROM pot!

n..lnIrucIuc:Iiotlol .. c-nb:.,....,~ .. ..-niIy1'lOlpitM .. bmO_1 ...... ~whid'I_....",.-by_ ....... IIIIhIn...,.. ... _ .. .,....,.n..IIOIIJIIaI ... _IOUy ................ ... ~~ __ tM.....-IO..-.cw~ __ .

.. OIOItlOdo .. 1<ty ........... wiItin"'t.:o.pobI_IO~......., ....

... -a.lIII*DoI"'.,....,IInd ... ~oI_...-:l n.. o.ptrtnWIIoIHMI1II_.., ~"'1O ~tI"~, _...,.. ........... ~oIIN syoan hM1g ~ r. opiQIIon for..,.,. ,......_ n..,,_....,_oI ... ....-1IIII ........ l*.IIId~ .. _

~_..., gukle IN RoIIJnd>o 1'Ioo.,;tIoI .... 1hIM ........ ThIt 11 Il0l10 AY

lhatIN RoIIJnd>olllaulc1no1 ... ...-.. .... II'._lICtf'n<lr4j ........ lil

lQIIII1y~for .. IAfI'"""""-lin .. ~IO~_ouI

~ ...... c-nb<~"""'~I\oIpiUIII.n..~ oI_doOfVlllilt......-. ...... for......".IiIIIII'III ...... -. ____ Iof .... wo .... "z ..... _IN.,....,c:cUd

t.irIpfo¥I<I_"IIIOt.""""'*"'-'.1I~1hIII""~ ....... _ ....... "'IIO __ illlf--*in~IO_ ..... 1N

di1W.-. ...- d ... c-nb: .,....,.

n. ..... oInioq ........... .,... ..... _ .... ..........,.In CMpIon;

,-,

I I cC/ttCLulION

~_boI_ffomlN~IhMIhIIr1I"'''''''''''''~wilhlN

In!rod~oIc-nt.Into ..... \efl'lllyllol!>bloetllng.6ameolthl ........

optdIk.lO~"",,",* ....... OItow1;IWIY~ .. ~patticipIotIngln

h Ctwri:r~ CM!*n 3 .... . wil6Ml1n ........... wilhlN IIjMdIIc: ..... _ .... RcuDthotpillllwil*"ln_oI .... ~oIHIPE --"-' ' ..... ' ......... _oI~~ ....... ' ___ _ ...... _--'c-..a.~~ ...... -...a,... __ .. _-...... __ ---~ ........ - .. -'I.-..' ......... _of ........ ~ ...... ' ___ _

~ .... _H_'_ • -..._~ .. C-._IIoopiIoI< . .....,.,_

........... _ ...... _._ .. _ ........ _....,.no_ c:...oI...,......'",,-I995.

Chapter 3: What ar. thto t;hal"~ pond by thto • • t.n.lon of

HIPe Into _ matemlty no.pltaJ Httlng1

31 MIMfW Of W Pm!

T1*~ 1ookI1ItIIIV • ...n.t1M HIPE syoIMIlI and "-.~

..... lhelXlll1lnMoflhec...-rnodoolftlMn~1M1I*iIe

~ IM HIPE IyIIem poMIlcrlM ~ HoI!lbl

3 2 Itm!QOlXjI!ON ID HIPIi

n. HaopbIInoPMiInI ~ Sc:h.-nIo (IflPE] .. II'1II "*' __ '" '-piIaI ~KIMty_IcrIM_..w.. __ MIIIbIII..:Ibylhe

MedIco-Soc:W "-'d'I_I ...... II'III_ ~ a-cr)tI 1872."

_-*'"*IICI~ID_.oriIhll'lllo..--oI_lIIkire_

~1cr1M_fn>m""""1_.

".,. HlPE .,...... .......... hoIIpbII. IM Ec:onorrk _ SodII R--" I ...... (ESAI) _IM ~oflOMth. ftll. otatIItIcaI dat.o.. 1yIIem, whId!.-<It _~ r.pa!ient~. Eacto In-priInI rIay" _ ..

• NloI~codH on IM HIPEd._.

n.~ ~ _ on hoIpUI"",,,- _ .......................

~ ofdllc/'l&'ge"""-" E8d1tePE raconI-...demographk: .... hoIpUIlUy....""...".,~ __ ... OII~

~. ".,._ .. ~on __ oohIc:fI .. IIod~1M

tePe.,......,(.eopy ..... """'IIInc1u11ac1.~31. ThiI_ .. 1I'IIIn 1llbmIII.:I1D'" ESRI who peIbm qu-ay-__ on"'_ ~. ".,. ~~ by'" .,.wm1l1l*lorouped ..... ~ OR<>-("'*'II ·0'0'4*" ___ ).1tiut~ adMIy --.

l I IlPl!IH"we"Y

~"hc-ra~."""""""IIIh"""'''pMiIoIIO

ra.r.g1'*"~IIf'I'IP_be ___ "'fIO"'d""""" .... InIIIIty. ____ '-9h

lllmr_.-..o .. pro:ry ...

............ III"Id .. ~ __ lorhY ... IIIIdy(""'*ICI ..

~l).~hY ... g""""_Ihey~ ......... 1aund1hM

.. -..nptlonlllleng!hlllalWf_nctklullor"OC»tIIIICII_ ~edmllhocl __ """""~1dIYt\I TlIIHIPE

.1IIm" h _ ~.""" in .... in l....-.d IOdIy

c.oa.c. lie !-FE"" ... wiIhin hllolpbl

V_ .............. .". .... c-P_hVllol_ ...... I\IIIionIII ..

~h~IIIH'IPE _ dIII ........... ...,....wy.iI

ThI....,. ~IIIHIPE ... ~ IdIYt\I dlUoblMllI ~ III"Id

r.o.pbI ........ ~ may be .....:IlorhlolDwlng~·

~ . ..-...u III"Id fIrdio'4I III ...a..".h o.p.nn.ntlllHallh

............", ....... ~.".~.EU. OECD .. -_ .... TlII ttPE .,....., ...... on HIPE --.. ....... CWI be ..... on q hIuIIry-

_~.,.,.........Ths .......... ~; .'- .... .""..~ .".-"III"Id __ lClda""' • ......-III ...... ~At"'l'

....... contu!..-.. hllpllxl.CIIl be d.,...,... on _ . "ThI __ IIIIIII

HIPE_en\ryfunt:ticlnIo.pUllllinbd ....... - .. Ad~1II"Id

~o.ta...-.-_1hedalllilkeyltcl, """"_III'1jK11od_

~*~~cIk'Ii:;ooI_---.._ .. quer\Id(",,,.

AS7.,-oId_hIrwIr9 .......... -.). In..,..,~ ... ~...- ... ..,.of ... _on......., ... oodto~ _ ..... n.toIIw .. ~~lIO .... llIO-*-I ............

daIIIlrom~fVSWM{ •. " P.tient~~)_'"

upbIod tt>e ~ _ . EKh rmnCh Iht daIII ."'" 10'" nMICIMI

HIPE d~ r.1he ESRI. n.dolro~ r'IOI nducIe ""tIn,..".1II1d Id:!IcInIc::I..-ooode.ln~bmonly. (~ ....... _onIy_ cocM.OM~ ... t.ctIl..t(.)N""Y~In • ...-~~)

3d IIP£IN DETM-

AIlIft"'lauoll'~1he .. PE __ ~~

~lII1dcA'*;aldalllon..m ...... ~*'I

... "'......., "''''­-­,."."'-

TM...-fuI __ oItn.HIPE"Y'o .... I...ptIII-....I .......... c:o-

0fd0'IaIId 1fb1..-.:I irr«IMmwI: 01. wIOt ~ 01 uper\IM. n.~.

wI"kh _ -. put In pllceln rrwrt ~""*"'- It. ~ oIe

HIP£ __ . ThiI....-.g.wllot-_ ~b' HIPE P*Y .-.:Ib ... _~.-.:I--..oI ... ~ . ...... _

""*,,,-"'JoIorIoiIn;I.

~-ol'Mdpn:l<*l .... tor .. e<>IiKtion....:l~dHIPE_ ... -R~""dat.lquUtyond~

~ "" .. 1>q)OrI 01 coded HIPEdat.I tolhl ESRI

~fortn.lUpplyolHIPE_..-.I...-v-to~ond --...... PIen .. ............,..oItn.HlPE~In ... wIIh ....... ond ........... ~oIeodIng",*"

PIIn nI ~ ~torHIPE .1....ptIoI_for IJIOWII --The HIPE CocIer 10 __ tor .. ec:anw ""'*'8 01 diId'l"VM r.om Ihe

dInkloI...........,.ontoIheHIPE_.ea.._I!1IiMcIIOU ... _

ooding rnechod !)MId on 1helnllrnlotionollICD _. by • oombO'IMion 01

ESRI tJWIinCI c:oo.n. _ onhjob 1nri'Ig. ~ iI ~1O_""

...a.tJMyolh'*"*""_ilnalli'I_ .............. b-.cocMdln. _ ... iI~IO .. ~ __ . Thiail ... __ .".iI

1.-d1O ...... ,..;:IMIy ...... _ORG.

N 1ItIIId.",....1faIt*Ig JarHIPE. Coden iI-.daIIO-.n .......

laopitaIacIM:y iI-otd ~. Thia'" ..-1hIIt .... HIPE Coden

_lodNot,r~ .. maIn .... IIw.,.,' oitiuo.oI .... HIPE~.

n-...... ..--...... outbelow:

PmcrJoII ~...., becl8lrw:f ..... CIOI"IIMIon-..l"klo aIW aILIdy.

_'-'<I ... b-.chIMIy"....,.,.,.t.IaJar~ ..........

admiIaIonlO .. hoapiIaI b-. Only _..-.....,be iliad.

"p!h:IpII~

1 ElciIItd"h_IlI"pdentI~inIohotpilalforwllit;t1 _ .... g;... ....

3. ThaI~"" PfICiar*_ ando'a "'9h III ay by ~

--'" ~ ....... lO ............ llIcao1I ... '""IcIo_no ~on .. .....-.thoapilalay""'"*lbe __ . F ... ...,..-ting

_ h RaIInIa tapiIaj ~ on CCldlrclIUII8 h

dIII\rIlIion 01 MoCcIndery cond __ fIWII be InWprMad .. additionIoI

condltiona dIM .1JecI patient __ In ..... 01 reqllirlnll·

tw:.I~Ot

~_""Ct _..-..... EXWIdId IiItIgIh d...,.. Of

Inc:t....ono.nio'lg_~~

~"nMI'I\IIIIlMIlhIrI ioll.lPPCWtinlldot:unlntltlonlnb.....a1c81

~/oI...,.diflg_"""""'-I.

AII~~~kIm ... 1hedldmloolonlD

..... o/~~belllledon ... ......:IicII_bcoo*'liJ ThiI~boCho ........... f ...... ~_ ......

..........pa.tOt~~.

SutgicellnMIuN

C ....... pra:ed ..... riok Ot

C ....... .....-heIicrilll

Md~ ...... ~ ... __ ~lnan_

--. Tha .......... ~ ... ~hI_~tor

datlnlllY.tr-...,..,.,.lhanb........,Of~~.

_1hII~_o/ ..... -.Of .. """OctI

belt "'*'- .". ~ dioograio"

n.~oIC01T'K1~oI*",,-n~~

~.............,. _ ~ C8llMlKtIN DRG ............ n c-r.

~. ~n.,.....,....shouIcI...-.ct .... ~_oI 11-.. ...... 01 .....

3 11 HlpF Afl &TIQNM1lp IQ CASflllX MODEl.

.... tIMId In ~ 1.3 INC. ...... ORG 11"'-" ~!WO..,..,. 01

_ . "'-PileI KtMty n "'-PileI_ldlJlll. n., ~ KtMtyo.Uo 11

gf'OUl*llnla 0R0.1n ... ~1O~ 8CIMly _ '-PbII.A

cNnllNillngthll""oI~tcmHIPEFIIo".c-na"""".1II _ . • 11 poMtIiIlO .... -V .-1IIenIiIm in .. HlP£ IV'*" 10 .... DRG

C*IIgOIyOtft ThiI .......... _ .. INgrOI.II*~. n.

~.uo-___ in_~ .. ",",00.( below'

~"~~lOpmwy"""lnIau.p

~c..tIogoriM("'DCI). b-.l~OIIbodyl)'l_orltle

f9IICidf\I . ...tIId'Ic. ... Iottto.m.

c.. Mo 1I.orthtt.pl -. IN IoIXa .."",..,..., 10 "'*'* or not.

~-~.

~_ ............ ..--.."",..,...,lO,........dItQrIoeIa.

$o.IfIIIr*_ ... ......,by". .... -....inIInIMo~

.-....tIId'III_IIII".pmwy~.

F""""diIQnOIIIiCor...-gic:lllIlUbgroupt; ... ~onthll __ oI

_.ur;tl_~~ .. ~or ~.~roomprccad_n~~

n-.~"""""_Ihey .. II....n .. t....~ .rIKtonlenglhrldy

I' H!Pr C'iALLEHQEII FQA lHf BOI\JIJtQl HOSPITAl.

The RoWndoI .... compIod • ~ ~ on c-nI:w 1nl co:I~, •

copy allhiI doc:tImIInt 11 Included 101"",,*,,* 2. /1"'" be _ from IhII """""*'I1hat.lotof~ __ ~donIlntlllRoCurd'lO_

will! tIII ..... ofHIPE. ttowe-.!hI lnIroducIIonolHIPE IrIIO till RQIUndr,

HoIpbI ...... runbIr 01 ........ The ..... IuuId rIiMd ................. -lnon:llt .. ~wiIh" ___ oIHlPE.llI--"1hII

~.,....blputln"'~!hI ......... _1hI

........ WormIIIon "'" beob!llro.d. Tt.. .. t!WII ~wIII*'!hI

ROI\IfId;I HoIpiboI Obetetrica. ~ 1nl p-.a; _1IJ)ItCiIIiIM .... __ MPf"1Itei'tbtllow:

ThIo-....s.~obtM-.lnIormIIIonon~

_from III diIdwgI...........,. --. ~

rIomIIIion III Il1o canIIir.t on till ~ -""""5yIWn(pAS). The~_ .. _ from .. PAS ~ "* .. HIPE

.,--. .. -...tIII--.tolciuplcltioto ~ In

III_.N.~"~~_"

bIO-Igcocled",*,!hIHlPE"""'ThI~_

""I'*Id lot !hi "HIPE -" ...........,. .......... liken

from III dil<:hlt;e...........-y -'- whIi;h woutj NI ...

-

bMn~by.c:Iinici.r!. ""t.~oI'" ~18d inIob HlPE.,-.. b "'-"* _ _ '""'"1hePAS.,.....( __ ...-.~ .••

~t> ........ ~ ....... by .... rr_ TNt_ ..... ...,."...'*"be~~

....... -....cyollhedaloo .. II ............. "­

quIIiily_cI'IIoc:b-..lclnalt-Ihrow'4'

_wtwe~or"""*,,,,-_noIbeIng

....:orded on .... ~ ..... n.. RoIIm. 11 CUIT8IlIIy

~on.projecIlOuaoWoIlNI""': ."..,.., ... _on. ~ bMlth "*,,,*_of

pMienII_ """'*" ....... 10 \lie "'"'"'*11"""""" "_MdinloIhllHIPE~ Mllhoptdlhllll'lio

_"~_""""""CUI'NI'II.,...., .. __ I_lObe~

~ ___ ..........ay~ondw

~'. PAS. 00 It.codirog 01"""" ... III no!

IUbjIcI Ioh .... aymm -.:rtbed _. n.. '**'"' ~>equinodbthe"HIPE_~~ ...

lllkenlromlhe~_ ThII ........ ,*tt-.. '-PbI.""ri"'QOI'ItNtOplorlllc:wo __ ID~

_"hNQlAwl_~.~.

_nat_Ior....-.plt~~

.......-....,--..... ~~

..................... clcYIwwtI __ r-

~ ....... '-V" ......... oflltlfl. lf ... c-_ .... ...-- ...,.01 ... HormIIIionon ..

OpeIwIiDn_ ... ,(I:N ....... lhnllinlull'donl Wormrion {e.g. no eMu ..... ~ IIwI ,. _ ;. __ ~ by .... eoa... n..Coder I\IrMg

~ IN m.t"""""",--__ (.~ IMIo

--

.. ..,........t...c.r-__ .. nocln .. _

~"'.drIi::iwI{onty • ...-ym.tox:~ __ .... ""~ ThlllilDIWIouoiIy..,.."kt.I

....... __ ~n~'**'"'*'

.,.,.., be ........ i lap'''' "' ... CodIw. Tt.

~"'NdrIi::iwIlnlNllnlomllllion~

~iI""""'n~""""beuicl'" be oompIeIeIy ~. n. hoIf>bIln 1Iw IIIIIriooo io

reIytng..,.~ ..... iI\ed_lomake __ 01 medic* chen._lotl'lOlaughly

~ud'I ~ n.1JyRIm'--'" be

tnrrW* .... "'IO~ men cInk:tIn ~1n ..... 1Ioof>II*,"""a.-... 1'CII -..:I\IftII"' __ ~.In_oI"'lnpuI

"* ... HIPE.-pWft, '* __ 1Wt.,. hoMIpbI C*'I __ c:or-..in ...... _ .. to.Ir'G ....

_ ..... PE.,......

P-'lMrlc:InfotrnMion~b\lle"HIPE~

..........oory __ 11 ~ obUon.d IfQm tM PMdiMric

.......,..,.,."""*'hil~'*'''' ... ~ __ . 1n

.odtion tile hoIf>bI"- log"'" • le! runbw of """­........ __ ~IIIhICOOW _

_ • ptOCIt(jI.Q, whid'I It IlOl Int...-IIII 01 --.(.~_'d'IIt __ ~b ..... ....:tlhe~.-..:. ... ~.",.,.ID be ....... ..... be dNd\'_ .... oy-..af

~-.-"'"" ... "'*"'''' ..... - .... _~tcmlM_""""'_'"

hoIf>bIilnotllll)lir'4jl .................... _oI • ....,.. ch.n. lhent .. _ ~ Ill" *'-IIM. ThiI twow.t lIowof~n.-.l co.

CJi*IIIiIOnIl ___ if .... HlPE~lIlObe

CII**d --,_ ... r.o.pbI.

It.,.,be~_fIoom ... __ .... r.o.pbIr.. .... '"'*'d cMlooenI.,.-..IIICJi*IIIiIOn"" ... -.dl"FE_ Itll-.odNr

_"'~""-''''~_II'''_IncIuIiIIe.~' ... 1IooPtII1I ~_. __ pert"'''"1IIoc*ion 11 c\eIwn*Ied

byc..nll<_",""I"~_"""""'lObIoomI

............ irI .... ~codirIg ptOCMa. 0IIw hoIpItoll wIIhIn ..... C ......

1)'8IIm M-..louncIlhlln.utIIcIenI -.tIon IO~" rogard 10 HIPE

codng r.. lid 10 Ihem bIIng on .... nog_ """" a/ .... c..nIlc ~

prtDII (h ~ d M 1JIWIIIICrI-- noI bIIng kC\.I1IWf

~""'HlPE~_IO""."- ....... "'''''''''''"'' ...-e _11 ~ _ . 111'" RcluncllIioIpUI. bIIorI ... ~'" c-I'III< ~ ... IIocIIion _ The RaIIn:Ioo .-gniIII. 1Nl I8ct __

II*d ........ -.0; 1O...-1t on • pn:1jIcI ..... (Irtion, -.by""

'**""" ........................ bIIng lid liii0 ... HIPE ~ ThiI pnljod ... _ rwo ....... hllrl .... ....,..1iM<Ibed< 10 ... lIoIpbIonllo

"..,......,.-.._ -..,.~ _ communicaollon ~

....... Ind .... HIPE INm _ .... ho&pIIII.

B. SUofIIng ~ & TrMWIg

n.codInlI"'dwairl .... _~""HlPEII"""""Y"'-PII*. _1C#IIWy __ ouc:tI"'"'IMqUre_~. n. ....

*'-d1O ... HlPE ................ IIIIin~Itd ... __

,*"" .. ~ •• fWty Iow_ ~ 11 ... 1'1). n. .... "'HlPEcodInlI __ ... ho&pIIII .... IOIooI<· ... ~

1IIIf_IO~W ... ...-e_.,.,be~tI:Im ... ~ "..,....._Ot~ •• _IfI'I)OinImInIr.."'be_.n.

~"'HNItI_....,.. ...... ~~...--..irllNo JIgIRI. n. ~ _1O_ ... ........mwcrlt ~ _ctoaMly

IlIIIiIdIon ... ~ "- Iht HIPE c:ocIIng pro<-."" CCII'I'IJIIIr'n """ __ III N ~ HoopiIaI, Iht!-WE prq.cI • .........,. ......... ~ 1ht1rldillolllll"*",,,,0I __

n.t.o.pbI .... ~_ .... ~~~ ... lhII

.,..., Moro; ....... mMIr .,..., 01 Iht t.o.p/IIl (HMIS) • ~ I.-d for ~inIonnMIan'" conII'aI. n.I1IPECIding . __ ... _

IMk. -..IW:tI • not proW;tII'Ig IroIorn-. .... ~ ThiI. bIoc.-h ~O!hw~.,.,.... ... __ .. beIng..-~ "*' thI HIPE t)'lWl'l. n. ..... ofsollww..<IItcuaed IIIdIUIiI fI poII'II F, .... 'MIII .. 1d 10 WJII'III'IG. ,...,..,..-,I ov-notnri'lg HIPE codM • • 1otG ....... ..,.",....~ofninF4;l ........ .ndCll'l ... job~AI __ HlPE oodIIrt -..:I.1wfO.dty -.:bytrtlrlq _Ill",

ESRI.Ihty"""doCll'l"'jobWJII'III'IGIDr~*"""' __

"'~_CII'IoocIing""~_""' ESRI . ThiI~. __ 1or .. __ inm.IY ____ 1hIt1t.~ ......

....... -. ................... Itq.-..:l(.....-.. t.cItNClht

<::<><*.,.,~Itq.-..:l"'lnIeo:prttmedictl~_IhIy ..... no ..-IlctI 1>tc:I!ground). 11 • .-0 euet'fItIlhtI .. """"' ... mIde __ of

.. lmporUono. 01,.. ~ !:hay ... doing tnd !he elfId ~ '*' ........ on the

hotpitIII"!:hay do not"""'CIIN 1heIr~.......:!tt, At tie*! t/:IoV'I m.ny

1Iotf>bII ... ,-~difIIcuItitt~Int\Ift'dtnI-.Iion_ p-'dlOo..-...;n.of .. _in .. irititlottgaol .... ptqtcl. n. __ .... 1O .. lhIIt.cIiw> ___ IhII ... codM ... ..-

_of1helr~"_fI!lII"LThiI __ """

",. .... of .... ...a.. _ on. GrIOt nloWa.1c81 -.-

_.~tt.-""CMDI*'I.a.m. lllIIVlOdMI~

ooIth .... ~ ............. upon_ ............. _of

lhejob. \IIIIIid'I_to. _ .... "boIYIg·wIIh ..... jab...--..

...... ....,I'00I ........... ~....--..,1nIMd IIWIY ~'-_I __ IO __ ... _....,.'-

"..."..thIm, *'--of.,. lid! of job ubIfKtion. In ",-,-10

1Idd .... thltprobilm,"" -..... -.. -"~ .... coding

wotIIlII'Id gMng Io'dM:IuM O!het ~ In 110 fa( .. . -. -n.... ............ of __ • __ lOto.~...- ... -0UIII0.,.,...,...,. ..... _.~~"""' ....

...... ~_ .. ~ ........... In .... c-n;"

Pf"IIG. n..-.....noc ... _'-PbIbUI_......, opodIIc~. ~ -..d~ nocto.~1O

indudoIlM R<lI\.I"dIo In .... of .... (:t).-.t;roupllof ~

_M-..d~to._.PI'fOI'IINIO_.

"""""'" glll<JPO'lg !of .......... 0ubIh ..-...y '-PItM. lNIo

......... diIocw.Md in <I.tIIiI -" cMJII- U

2. ~holIpboIIlII'Id-..ly~_IO_'-' ~"""'''''r.Io6IL n.. .. ......,. ____ .... _ .. .....,.I\ghI*'--IhIo __ I~ .... do.

""'~.,.~~wllhnwtemllrc... n.,. ___ tt.- ....... NuIftciInI oodM In .... CUITWII

'\'*MIO~reccnllM-"d.~~.

ThII '-et _ ~ .. -..... c..nt< fY'*II.

.......-_tt. _c-na..,.-" .......... , IItI.wiIh .. ......,.,. _ n.,.-.cIId tt._ .... -a Md~ n.,.~~DAo.'"

~..-.opic~Md",~btt.

~""-afot.lalricpllCilr'U""_Md~

-.pbIIonLIncIuIIodM~l •• lIMaf~

codM/COnd_ b • aMnPW""- 01 DAGo, w!Ik:t! the

............ ~ af HuiItI ..... dr-. up. H!My tMo

~ b Ihe Dep-...c 01 HMIIh henI '" <XInIIdM IhII

...... ....o..-..tt. ........... ~"' ..... ""'*""'". IUitablllIOIht IrilhULQlion.

n.. InRdudIon 01 c..nt<..., tt. RaCL.ncM HoepbI"'_ ~ ~""'Ihe~. n.."'*-Icn.ng. ......... IrnpM:ta on boCh lhe SpKWIy eo.tirog Md HlPE ~ af Ihe MocIeI.

n..1II'IIcb" _alSpooc8IiIy eo.tirog.,.ditc\ItMd In C .... ... 6

....0 ......... to Ihe HlPE etIodI. n.. "'*' ~ tl>M wII tMo

.-.quItm from. HIPE vIowpo;tII. whidI_"'- '" _ .• In

...... af.",....,....~lnlhe_<:CIdlrG~.

C--.. Ihe __ inlhit_ ..... "''*'''''''irMlMd''''O

.. ~b~..,.......""O~ .... whod!

...,..tt.c::cxIng .......... n.,. ..... "' ........ -......wiIh

... tnn:.ciMo aflhe_ Md 1My- ..... 110 """ ..... in ....

.......... If ... ""'"""""~ irMlMd Inlhe c...nIx ...... ..... 1Iw ............... "'~ __ .t.eoon. ~ ..... lhe~to __ tt.dIMng**"' ... _1O ........ 11* '-'-" ... "'PIUNd _ IWDCO:1!ed on lhe HtPE

~n.I'IoIPtIICWW'W3Itw:Jp.todo_~""""" .,....,--..... to_II .... ~bcio'tilo-.to~~In ....

~al .... t.:.pbl.To .... cIrtiIft..-. 1n ~'- t..n hitr -"*'d _ '- t..n In ..........

~to .... _al .... I'IoIPtII .~ .... ~

_ ...... u. l...,al1hoI.*I1Iond .... 1OWJtd ...............

~1I c-rixiltobe.-d ...... ~~1Cd

..tIhInIheRotuncIa,lhenthil~and~iI

...... ~. n._cl~ildito.oMed-'E._ .

. -A ...... ~b .... RoIundiI~ .... C-*..,...., iI~II""""'oI~.n.~

cI"IIomIIt ...... IhII~~tobeopeowdn~. AI

~1O .... .........-~to~ ....... _1n1he ~ pRX>Ma but ...., Ihete .-10 be , _~ tIow allnfonMtion

'*-' 1hI HIPE n SpeciMty CoAng petIOIIIMI. AI -. aopocII

_....-.dlltolhllc:-r.ix~.iI ... lhlllhete.

COI'IWI'Ori:III_-. .... n..poIntil ... ~1n

~4 n.cunwnlmoIhcxIal~b,*"",~ ____ ...,.be ............. _~- ..... tIIiI

iI~ln~detIi ChIpIer • . 8C.(b)). l1*n ....... ...... ...,.lIOIbe~I_.IIOI~ _

_ ~. II.._~blhel'lolPtlllO_on'"

combInId , __ al1t-.two "'*'" In orOtrlO....-- n __ 1hIC.-nbI~IO-.ciII~.

.iI"~"'''I*'""aw.-af~~'''' ~hoIpiIaI_"_",,,,-~loI""c-*

...elM. A1..,- .... ..-nily ......... -"lrG QII ...... of

johco-opwlllion III 11_ T1wy_~~.1Drum

-.by_~"'""'IM_I'IIIII>bII"'~ .... 10 diIo:uM ...... of join! """,,*", _ on M IroIonr*_

IM tvmItII co-opt<Mion IhouId t.. ~. ThII ... t..

MMon\lOlOUlll'om" par.tofYlew cf~._~ ........ _--"'IIIhM_il~~ .. _

l'ICII!lbII . tt"'_'-~"'lXIfI1fI'UI01IInlNmm-n1M

~af_"""IhIII'-t...Iirowotv.dlnlMc-nII<

~Iot_~_"~_"-_IM

1'I'IOdtII ........ -.

n... __ of_ilSOITIIItNng......", .... ~""""to

1IIId ... r. iI...., M __ inlllml cf1hl8pldlllil'fCollin; oyown,

~ inCIIIpW '-4) . ....,. ~ iI M*'IIiII foI .. '-Pb!I"'_ 1M __ Io ....... ~ • • ~t..pr....-1DI1M

hcIIpIitIIo ... bI_ ........ HlPE.,...,blnlilrNl~ ___ .....-__ b~ ...... c..-..

prq.:t. n... Rcu.s. hoIpiWl CUIIWII ~ pn:MdI _ $IIIId

"*""-........ HIPE.,..., _~. illhIIr .....

.,..., rIIItw .......... HIP£ .,...... wNctI iI .....:I by InIImoI

~~IM~o/IcUd'*'Yout M_on

hoIpitaIl)'IIIInI"~~_''''''loupclMJ\glM

c...... ..... InIO.ldl.W8)'_"'..-c_ .... ~ ...

"'-'-PiI*.

G. OIAPItiwll:~{OPO)

AI OPD 11 .~ciI.Ic*Ilrom'" CIIrfWIt c-nb< ......w. 1he RCIIuncIf,

...... to~ ... c ......... prac:eclutHln.".OPO ..... 1lCI

"""""" IhoH prac:ecI ..... '" tile 0II\It hoIpiUII wIIIIkIlt'l group /or

budget..tjuotr....t~. ThiI rlYilwll--V "' ....... 1hII

.... hoIp/IIII ... '*'" IN.-cI ~ ... ~ oriIh r.pd la 01'0 IdHty ThI RaIurdII ,.... 1I......-.IIy pIIbmIng _

~InIMOPO __ .,....,...,_~on.dIy

_-....Mdlyc.- ... inc:bledwilhln ... modII ... OPOII 1'IOl,11I~"'''''''1hiI_.1l1mpor\a'It1O __ 1M

1oc:MIon .... of"...~IItIIct_. ThI ....... ""'"

01'011_"""'''' c....c.......w 11 ~IM ORa ayNIm

_~IOCOVIfIn-prier1"orIy. An.......w.""~

1)'IIImIlr.quiNdb~~II~~tMIthi1 ....... 11 oor>Iidef.cI .......... _ DubIn mNmIIy hoIpbII. The

_to ... OPO ....... _noIyeI_Iound."""Y ......... "'* 1hII. _ compIer: eodIng syalllm .....,. be fIqUbd . .. ICD-i-CM

d.-I"IOI ~ Mc:rbI"~ 1dMly. ThI DIpItImIrII: of

H111f16IcWon ~ OPO"'~ t-.. irnI*ton InclhldullhoIp/IIIIln_o/c:ocIrog-. ... thillI~

... RQCurda ......... ~In ............ """"".,...,.. ... --

! I r9HC' "lION

n.l1F'EmodeI .... ~ .............. c-nI!! ........ 1t.. ~h1 __ Iof' ... prcducIon ....... IIIIc:Iwge ............... wNct! ..

.. --.tiI!I~inbuclgt!t~~. lI.iI--"'_ 1hM ......... __ IhM.~ ............... ~_

PfOO'd ..... 10 IhM It. KIMIy ....... tw::.pitIII c.n ~ ~ ........., in

... model. h iI ...., IIIM!'IIiIII '"*I ... Aotpbi .......... "" It. imp.:I HIPE

1.-...,'" C ...... mocIII 10 '"*I" 1Ig_.aMly .. 1<IenIiIIIId and - .

. _ ...... c..-..~..-. ..... ,_

CHAPTER 4: Wh.t ehallengn are poNd In the ':o:t,nalon of SpKlallty eo.tlng Into a mat.mlty hOllpita.1 MttIng?

4.' OVEIMEW Qf ' HAmA

Thltc/'4lplerwllo<*lInIIy.c_IIII~~""*,,II_howl_""'1he

c..mbt rnocIIIl M wllIwI kientiIy tt. tNoIIengeI tt..IlIII Rot....s. Ha.pI\III'" '- In

intlodld'lgthlll""*,, .

• 2 !HTl!9Q! ICDC!N m '""i,e, rry pomrtg

,..~......-~.I'apW.~In_of[)ft(M ... IO"""'" • _...--..Ing of.,.lIdMtyoftt. ~"WIII'" ..... ~~.to.. ~ .... _~ ... _~to!"""of~. """"*'"c-ri:< ........ ___ of.,. __ ~~to!.,.

-' of. hoIpbI". c-ri:< .... __ hoepbI .... tIIt.......-..et M DRG __ ..

sn:...,;to DRG III UfI'CIMI to "",....,.. • ca1IIn ~ 01_ • ....we to II1Y _ ORG IIIIng l1li ..... -w..lll inpoItIntb ~ 1O"*""'t. .... COlI 01

_DRG. IbpItIoI_ .. ClO:TW1dy~YiIIIhe~<:CIUIn;J""-"'VHe

"'~-*'II",,*,,""'.bpmwy""lhello<ri;lno/_to........a..t

~. IIMIInbmIIion kIm Ihe ..... tIIgIM 0I1hII.....-dIM "'" be ...aID ClCIII ORG.. Tlw1J*Cl*ll-*'ll ~ ......... ,....,.. oI~COIt __ to! -' . "...

.-,-.-.....

c.-.. ~IO __ COII __ ..-d"""lIfIPhdIODAG""'fRIm __

COlI __ They .. ~ 10 DAG .......... onllw t..-dDAG-w:. ........

..... cWJ_whItII ... luncbond ... l8rQthdll8y n._ildaiI8IIi'I

""" • . Sbllloor

y $P1'ClAIITt CQ$DNO IN $I ' PUY

In ... 1I'rotI1O"~ IIw InkI _ t.o.pbI KtMly..-d __ It-. MIIm8Ied <:0$11

1* DflG ~ 10 ~~. Ihuo lh8 DflGCOII ~ _ d8YeIoped. Tt.dotll

_~IO~IIwCOllIllOdel ...... foIowt;

. P.ciItCdit<:II8rg8~

• P.ciItC.-.Icw~ .---• _ ...... b~--"*'.

WWtwd~In""'~~IoaNtt_c..tIi'I"""'~' '''SluctVof Ho.pbI C-*" -."' __ ... "'" .... lnllw ORG _1IndWIg __

TliI .... ___ ....... d .... _inlhe~lIdgIrlOloIII8I __

FHe~ ..... _ .. .....-.:tb,.WWt&~in .. NOMI.~

.)&411""1 ......... ; -.~. -............,.

b).......,. ...... g p!wmEy. t.b<nIory. _...ticJIcqy

c)CIinicaI ....... II...,..;"g.

d) ~ ........... ; . -..Iry .

• )Nonin1>otlent ..... ··II ·~~II.