1. During 1984 and 1985, labor hours per case-mix adjusted discharge declined by 1.8 percent and 2.1 percent, respectively. This productivity improvement is tied to the large drop in inpatient lengths-of-stay during that period. Once lengths-of-stay stabilized in 1986, labor hours per case-mix adjusted discharge began to rise again—1.6 percent in 1986,1.1 percent in 1987, and 1.5 percent in 1988. For these calculations, labor hours are adjusted by the skill-mix measure developed by Cromwell and Butrica (see Note 1). The measure of case-mix change used is the estimate of real case-mix change developed by the Prospective Payment Assessment Commission (ProPAC) staff. This real case-mix change estimate does not include increases in case-mix that likely reflect improved coding of cases as opposed to changes in actual severity of the patient mix. See Prospective Payment Assessment Commission
,
Report and Recommendations to the Secretary, U. S. Department of Health and Human Services
,
1 March 1989
(
Washington, D.C.
:
ProPAC
,
1989
),
63
-
64
.
2. New York State Department of Health
,
New York State Labor-Health Industry Task Force on Health Personnel
(
Albany, N.Y
,
1988
).