MANAGEMENT OF HOSPITAL COSTS

MHS HOSPITAL PROFILES

DEFINITION
MHS Hospital Profiles identify the costs of inpatient treatment, as well as all other costs associated with hospital admissions. They also evaluate and describe the claims cost profiles of individual hospitals and hospital groups.

• Generated quarterly and annually, utilising retrospective data,

• MHS Hospital Profiles consist of the following suite of complementary reports:

• Admissions reports,
• Ward stay reports,
• A Ranking of Hospitals By Cost and Number of Admissions,
• Hospital Procedures summary reports,
• Report on total cost to the medical scheme of procedures performed,
• Expensive procedures (exceeding national norm by 30%) exception report,
• Quarterly statistical summary.

• Form the basis for negotiations between client medical schemes and hospitals/ hospital groups,

• Comparison of specific procedures and Lengths of Stay (LOS) at individual hospitals with national averages and an average for specific medical schemes and/or groups of medical schemes,

• Comparison of add-on costs per hospital admission for each hospital with averages,

• Can be used to develop and maintain Diagnosis Related Group- (DRG) based fees, Fixed Fees and Per Diem hospital reimbursement,

• Enables implementation and management of hospital accreditation programme and PPO hospital networks.

• Provides the norms for a hospital pre-authorisation programme,

• Provides medical schemes with norms for hospitalisation costs and information on expensive hospitals that warrant follow-up,

• Direct interventions regarding procedures that are costly to the scheme,

• Provides medical schemes with management information and management tools to measure the cost-effectiveness of interventions with hospital providers.