Systems Research and Applications Corporation. Arlington, VA, USA: Systems Research and Applications Corporation.
Systems Research and Applications Corporation, Arlington, VA, USA
The Office of the Assistant Secretary of Defense for Health Affairs [OASD(HA)] has undertaken a phased assessment of the more promising ambulatory care case-mix methodologies as potential resourcing tools. Before this assessment of Ambulatory Care Groups (ACGs), we studied Ambulatory Visit Groups (AVGs), Ambulatory Patient Groups (APGs), and other methods for potential application in the Military Health Services System (MHSS) environment. Data sources for these efforts were the Uniformed Services Treatment Facility (USTF) database, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) claims, and the Army’s Ambulatory Care Database (ACDB). While no approach was completely ruled out due to inadequacies, one approach seemed best suited to Department of Defense (DoD) needs – APGs. Previous studies also found that the Resource-Based Relative Value Scale (RBRVS), currently being phased in by the Health Care Finance Administration (HCFA) as a means for reimbursing physician services under Medicare Part B, is superior to CHAMPUS dollars as a resource measure.
During our prior assessment, we became aware of a new approach to case-mix classification developed at The Johns Hopkins University School of Hygiene and Public Health. Entitled Ambulatory Care Groups, this approach is unique because it adopted a capitated strategy to case-mix classification. While we were able to brief the DoD project technical advisory group on ACGs, there was insufficient time to incorporate them into the comparative analyses. In the interim, the use of a capitation-based resource allocation methodology has become a core component of DoD’s TRICARE Program (TCP). Consequently, Ambulatory Care Groups present a significant potential for application to the TCP.