Hayoung Park

Diagnosis-related group refinement with diagnosis- and procedure-specific comorbidities and complications.

Diagnosis-related groups have been revised through more refined uses of secondary diagnoses. Under the refined diagnosis-related groups, patients are distinguished with respect to classes of secondary diagnoses that are disease- and procedure-specific. Each class represents a different level of utilization for a given principal diagnosis or surgical procedure. The refined system was evaluated with national data from the Medicare program. Estimates of hospital costs and utilization based on refined diagnosis-related groups were more precise than those based on unrefined diagnosis-related groups. This approach to diagnosis-related group refinement does not represent a radical departure from the current diagnosis-related group framework and does not require new data collection efforts. Moreover, a payment system based on the refined model is less affected by the ordering of the diagnoses than under the existing diagnosis-related group system. How the refined diagnosis-related group framework can accommodate future refinements at all levels of the classification scheme is also discussed.

A scoring model to detect abusive billing patterns in health insurance claims

We propose a scoring model that detects outpatient clinics with abusive utilization patterns based on profiling information extracted from electronic insurance claims. The model consists of (1) scoring to quantify the degree of abusiveness and (2) segmentation to categorize the problematic providers with similar utilization patterns. We performed the modeling for 3705 Korean internal medicine clinics. We applied data from practitioner claims submitted to the National Health Insurance Corporation for outpatient care during the 3rd quarter of 2007 and used 4th quarter data to validate the model. We considered the Health Insurance Review and Assessment Services decisions on interventions to be accurate for model validation. We compared the conditional probability distributions of the composite degree of anomaly (CDA) score formulated for intervention and non-intervention groups. To assess the validity of the model, we examined confusion matrices by intervention history and group as defined by the CDA score. The CDA aggregated 38 indicators of abusiveness for individual clinics, which were grouped based on the CDAs, and we used the decision tree to further segment them into homogeneous clusters based on their utilization patterns. The validation indicated that the proposed model was largely consistent with the manual detection techniques currently used to identify potential abusers. The proposed model, which can be used to automate abuse detection, is flexible and easy to update. It may present an opportunity to fight escalating healthcare costs in the era of increasing availability of electronic healthcare information.

Can Additional Patient Experience Items Improve the Reliability of and Add New Domains to the CAHPS® Hospital Survey?

CONTEXT The Centers for Medicare and Medicaid Services will introduce the reporting of patient surveys in 2008. The Consumer Assessment of Health Care Providers and Systems (CAHPS) Hospital Survey contains 18 questions about hospital care. Internal consistency reliability of the discharge information scale is relatively low and some important domains of care are not represented. OBJECTIVE To determine whether adding questions increases the reliability and validity of the survey. DATA SOURCES AND STUDY SETTING Surveys of patients at 181 hospitals participating in the California Hospitals Assessment and Reporting Taskforce (CHART), an initiative for voluntary public reporting of hospital performance in California. STUDY DESIGN CHART added nine questions to the CAHPS Hospital Survey; two to improve reliability of the discharge information domain, five to create a coordination of care domain, and two relating to interpreter services. DATA COLLECTION Surveys were sent to randomly selected patients from each CHART hospital. PRINCIPAL FINDINGS A total of 40,172 surveys were included. Adding the new discharge information questions improved the internal consistency reliability from 0.45 to 0.72 and the hospital-level reliability from 0.75 to 0.81. New coordination of care composites had good internal consistency reliabilities ranging from 0.58 to 0.70 and hospital-level reliabilities ranging from 0.84 to 0.87. The new coordination of care composites were more closely correlated with overall hospital ratings and willingness to recommend than six of the seven original domains. CONCLUSIONS The additional discharge information questions and the new coordination of care questions significantly improved the psychometric properties of the CAHPS Hospital Survey.

Development and Evaluation of Korean Ambulatory Patient Groups

With the prospect of rapidly growing health insurance expenditures, particularly spending for ambulatory care, the introduction of a case-based payment method is discussed as an alternative to the current fee-for-service based method. A system to measure case mixes of providers is a core component of such payment systems. The objective of this study were to develop a classification system for ambulatory care, Korean Ambulatory Patient Group (KAPG) based on the U.S. APG version 2.0 and to evaluate the classification accuracy of the system. A database of 64,258,386 records was constructed from insurance claims submitted to the Health Insurance Review Agency (HIRA) during three months from August 2002. A total of 41,347,307 records with a single visit was used for the development and 7% random sample of the database was used for the evaluation. Additional groups were defined to include both physician and hospital fees in the classification, age splits were added to classify the entire population as well as the population older than 65, and the definition of medical groups used by the HIRA was adopted. The variance reduction in charges achieved by KAPGs was computed to evaluate the accuracy of classification. A total of 474 KAPGs was defined compare to 290 groups in the U.S. APG. The variance reduction for charges of all visits ranged from 20% to 37% depending on the type of provider, and ranged from 22% to 42% for non-outliers, that were better than those achieved by the system currently used by the .HIRA for its internal review purpose. Although further study is required to improve the classification for complicated care in larger hospitals, the results indicated that KAPGs could be used for better management of costs for ambulatory care.

Development of biotechnology clusters: the case of Daedeok Science Town, Korea

The development of biotechnology is particularly challenging to developing countries that must transform their manufacturing-based economies to knowledge-based ones despite the high development risk, lengthy development times, and technological dominance of a few developed countries. Some are implementing clusters to develop the biotechnology industry. In this study, we examined the emergence of the biotechnology cluster in Daedeok Science Town, Korea, through a social network analysis of collaborations in innovation; in addition, we examine the association of economic performance and the network properties of small start-ups in the Daedeok cluster. We conclude the report with policy implications for countries with an economic agenda to develop the biotechnology industry.

Refinement and Evaluation of Korean Outpatient Groups for Visits with Multiple Procedures and Chemotherapy, and Medical Visit Indicators

Hayoung Park, Gil-Won Kang, Sungroh Yoon, Eun-Ju Park, Sungwoon Choi, Seunghak Yu, Eun-Ju Yang Technology Management, Economics, and Policy Graduate Program, Seoul National University, Seoul; Department of Health Informatics & Management, Chungbuk National University College of Medicine, Cheongju; Department of Electrical and Computer Engineering, Seoul National University College of Engineering, Seoul; Classification System Development Division, Health Insurance Review and Assessment Service, Cheongju, Seoul, Korea

Competition in the Hospital Service Market and Its Impact on Hospital Behavior in Korea

How health care providers compete and how competition among them affects their behavior are crucial questions in theory and health policy. In ordinary markets, competition improves social welfare, However in health care markets facing uncertainty and information asymmetry, competition can take the form of wasteful quality competition and result in cost increase. The purpose of this study is to examine the characteristics of hospital service markets and examine the impact of hospital competition on hospital behavior, more specifically hospital cost and the size of personnel. Based on patient discharge data of 2002 by the Ministry of Health and Welfare and Korea Institute for Health and Social Affairs, and health insurance EDI claims data of 2002, this study measures the degree of competition in the inpatient service market of hospitals, using variable radius method and Herfindahl index. The result of the study shows that the hospital service market consists of on average 3.13 government administrative units(shi, gun, or gu). Compared with hospitals, general or general specialized hospitals cover larger markets and operate in more competitive markets. Nearly 60% of patients use hospitals, which are not located in their government administrative units, meaning that market definition based on variable radius is better than the conventional method of market definition based on government administrative units. The results of multivariate analysis show that competition is not associated with high cost index of hospitals. But hospitals in more competitive markets employ larger(more intensive) input of personnel per 100 beds, implying that hospital competition in Korea can have the form of quality and cost-increasing competition.