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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…
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Grouper Software Research Medical Grouper Systems are primarily used by healthcare organizations to evaluate information on the quality of patient care, treatments and medical expenses. This is achieved by categorizing all patient claims (pharmaceutical, internal and external) 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. This grouping helps in performing a number of data-intensive and complex tasks like disease monitoring, cost analysis, utilization efficiencies, case profiling and quality assessments (Pavlock, 2009). Many of these grouper systems are capable of operating independently through connections with appropriate data sources while some like APC offer the unique capability to plug-in with other existing systems for performing their tasks. 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. Some of the top companies offering grouper systems (along with corresponding market shares and grouper functionalities) are listed below. Many of these vendors provide more than one type of grouper systems discussed above (Scott, 2010). Thompson Medstat (26%) – disease categorization and evaluation AHRQ (15%) – diagnostic classification 3M (12%) – DRG Grouping, severity classification HSS (10.5%) – APC & RUG classifications Several surveys by researchers like Valentine (2009) and Sommers (2008) have concluded that most grouper system vendors charge anything between $50,000 and $100,000 for a single grouping system capable of a specific function like expense or illness classification. They also note that prices increase between $300,000 and $1.5 million for a full-fledged grouping system capable of providing multiple classifications including many of the ones discussed above (Cohn, 2008). These prices include the costs of hardware components and installation charges. Companies also arrange service-level agreements (SLAs) to provide maintenance and customer support which are renewed on a periodic basis for an appropriate fee. Bigger companies like Thompson Medstat also provide training to educate potential users on the various features and workflows associated with grouping systems (Sommers, 2008). On most occasions, the fees charged for all such supplementary services are comparable to the cost of the system itself and thus form a core component of vendors’ revenue. According to Pavlock (2009), grouper systems are used extensively across most hospitals and are mandated by the government to be installed and operated by every healthcare organization in the United States. References 1. Cohn (2008). The Business of Healthcare: Improving systems of care. London: Greenwood Publishing. 2. Pavlock (2009). Financial Management for Medical Groups: A Resource for New and Experienced Managers. Chicago: Medical Group Management Association. 3. Scott (2010). Implementing an electronic medical record system: successes, failures, lessons. New York: Radcliffe Publishing. 4. Sommers (2008). Medical group management in turbulent times: how physician leadership can optimize health plan, hospital, and medical group performance. London: Routledge. 5. Valentine (2009). Medical group management: strategies for enhancing performance. New York: Jones & Bartlett. Read More
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