Diagnosis related groups and the price of cost containment.

209 Yet, disease staging is not without its disadvantages. Certain diseases cannot be staged.210 No actual statistical measures of resource consumption are utilized in categorizing patients.21 ' Disease staging also ignores concurrent conditions and patient-related variables which affect resource consumption.21 2 Disease staging may prove very useful in the refinement needed within the diagnostic groups of the DRG system. By blending the advantages of both systems, a new and possibly better case mix measure may be created. Patient Management Categories Blue Cross of Western Pennsylvania 213 introduced a Patient Management Category (PMC) approach to case mix measurement which goes beyond the DRG system. Instead of measuring case mix by diagnosis at the time of discharge as done by DRGs, PMC also examines the reason for hospital admission. 2 4 The underlying theory states that the reason for admission as well as the ultimate diagnosis will affect the length of stay, the resource consumption, and the total cost. 215 Comparing PMCs with other case mix measures, similarities and differences can be seen. As with other measures, PMCs were developed with initial physician involvement.21 6 Levels of severity are considered from a clinical perspective.2 17 Unlike other systems, however, PMCs focus on the patient's clinical characteristics. 218 Rather than examining how the patient should be treated, PMCs look to the services, the procedures, and the ex207. Plomann & Shaffer, supra note 189, at 441. 208. Id. 209. See OTA Report, supra note 4, at 17. 210. Id 211. Id.; Plomann & Shaffer, supra note 189, at 441. 212. E.g.. age, family support, overall health status; See OTA Report, supra note 4, at 17; Plomann & Shaffer, supra note 189, at 441. 213. See OTA Report, supra note 4, at 18; Plomann & Shaffer, supra note 189, at 441. 214. See sources cited in note 213. 215. See OTA Report, supra note 4, at 18. 216. Id.; Plomann & Shaffer, supra note 189, at 441. 217. See OTA Report, supra note 4, at 18. 218. Id.