Fred Levinsky, President and founder of St. Paul Computer Center, is the Senior HSCRC Project Leader (He has done this for the last 16 years). Mr. Levinsky coordinates the HSCRC Project team. Mr. Levinsky has 30 years of experience in case mix processing, and statistical analysis.

Bob Lewis, Senior Vice President of St. Paul Computer Center, has designed and programmed all of the current case mix systems that collect, edit, process, and report patient abstract information for the Maryland HSCRC. Mr. Lewis has 30 years of experience in hospital reimbursement, hospital A/R systems, DRG grouping systems and cost accounting systems. Mr. Lewis is also working on the new Enhanced APG Ambulatory Patient Grouper for outpatient services.

Richard Vincent, Manager of Statistical Processing, is responsible for the integrity and the output of the systems, and also the programming, processing and controlling of the case mix systems. Mr. Vincent also acts as a liaison between St. Paul’s staff, the HSCRC, hospital contacts and the staff at St. Paul. Mr. Vincent has also been working in this capacity for the past 18 years, and is also working on the new Enhanced APG Ambulatory Patient Grouper for outpatient services.

Understanding the nature of Increased Medical Costs

The state of Maryland is faced with the regulation of increased hospital costs, increased emergency room visits and utilization, pressure from payers to reduce hospital costs, nursing shortages, and increases in the uninsured population. In response to this, case mix data is used to help control hospital costs and to measure hospital efficiency. Maryland hospitals currently have a waiver from the Medicare PPS reimbursement methods (no other state has this type of waiver). This waiver requires the HSCRC to regulate the hospitals in order to maintain average charge corridors that are below the national averages. The HSCRC monitors the efficiency, charges and performance of the hospital industry through the measurement of changes in hospital case mix indexes and charge per case using case mix data.

Maryland is an all payer state, meaning all payers receive the same reimbursement. St. Paul, in conjunction with the HSCRC and major consulting firms, used the case mix data to develop and produce the APR CMI monitoring mechanism used by the HSCRC to measure changes in case mix at a hospital. This included the development of hospital specific revenue trim points, the development of categorical exclusion data (organ transplants, burn cases, etc.), Level I CMI (data without trim revenue), Level II CMI (data with trim revenue) , and Level III CMI (data with trim revenue and categorical exclusions).