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Grouper software research - Essay Example

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Medical Grouper Systems are primarily used by healthcare organizations to evaluate information on the quality of patient care.This is achieved by categorizing all patient claims into distinctive analytical groups that contain entire information on the patient’s diagnosis and care given in response to each individual illness or medical condition.A number of vendors are engaged in the design, development, manufacture and maintenance of grouper systems. One of the most prominent systems provided by vendors is the DRG (Diagnosis-related Group) suite that organizes patient cases into any of the 466 classifications configured in it. The DRG offers several specific systems for managing patient case information on attributed like disease severity and Medicare (Cohn, 2008). Another class of grouper systems that is widely used by the healthcare sector is the ‘Ambulatory Payment Classification (APC)’ (Scott, 2010). As the name suggests, the APC is used to classify outpatient cases according to various clinical parameters for the purpose of reimbursement. A third popular class of grouper software is the ‘Resource Utilization Group’. Like the APC, RUG-based grouper systems provide patient classification of resident patients to determine the appropriate amount of reimbursements from the respective federal and state governments (Pavlock, 2009). The RUG allows classification of patients into one of the 44 configured groups and assigns a score, based upon which the necessary reimbursement amount is calculated.

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Summary

Medical Grouper Systems are primarily used by healthcare organizations to evaluate information on the quality of patient care.This is achieved by categorizing all patient claims into distinctive analytical groups that contain entire information on the patient’s diagnosis and care given in response to each individual illness or medical condition…
Grouper software research
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