0000000000924127
AUTHOR
Brant E. Fries
Applying RUG-III for reimbursement of nursing facility care
The Resource Utilization Groups (RUG-III) case-mix classification is becoming an internationally accepted methodology for determining payment for nursing facility and care. In this paper we discuss the key concepts of case-mix reimbursement and several different payment approaches based on RUG-III. In discussing the empirical evidence of case-mix reimbursement, we draw especially on the US experience. Clearly, the success of case-mix reimbursement depends not only on the payment design, but also on the ability to foresee market conditions and the regulatory environment in which the payment system is being implemented. Moreover, we demonstrate the need to develop a case-mix based reimburseme…
Validity and reliability of Resource Utilization Groups (RUG-III) in Finnish long-term care facilities
Resource Utilization Groups, Version III (RUG-III) is a case-mix system developed in the USA for classification of long-term care residents. This paper examines the validity and reliability of an adapted 22-group version of RUG-III (RUG-III/22) for use in long-term care facilities in Finland. Finnish cost weights for RUG-III/22 groups are calculated and different methods for their computation are evaluated. The study sample (1,964 residents) was collected in 1995 - 96 from ten long-term care facilities in Finland. RUG-III/22 alone explained 38.2% of the variance of total patient-specific (nursing + auxiliary staff) per diem cost. Resource use within RUG groups was relatively homogeneous. O…