The Complexities of Case-Mix Adjustment

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Abstract
To the Editor: The fairness of the present Medicare prospective payment system to hospitals, physicians, and patients should be reviewed by the Health Care Financing Administration. Jencks and Dobson (Sept. 10 issue)1 state, "A hospital will be protected if payments are adequate when averaged across all discharges in all DRGs [diagnosis-related groups], even if the payments are not adequate for each discharge." Even if this were so, the physician who has only a limited number of cases and the patient who has serious complications will not be protected by this concept. The variables that should be considered in a case-mix . . .

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