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PubMed2000

[A trial of prospective payment system (DRGs/PPS) in Sendai National Hospital].

This study was undertaken to compare the difference between the total payment that was actually paid in accordance with the rules of DRGs/PPS, and the medical fee calculated by the present Japanese medical insurance system. From Nov. 1st '98 to Oct. 31st '99, the DRGs/PPS was applied to the 1,723(21.4%) out of 8,042 acute inpatients who were discharged after short-term stay. The total payment by the DRGs/PPS(yen 1,450,725,370) was smaller than the medical fee by the present Japanese insurance system(yen 1,504,686,240). In MDC (Major Diagnostic Category) 1(nervous system), 2(eye), 3(ear, nose, throat) and 4(circulatory system) the payment by the DRGs/PPS was greater than the fee calculated by the present medical insurance system. On the other hand, patients who belonged to the other 9 MDC groups paid smaller amounts by the DRGs/PPS. The major factors accounting for the difference(yen 53,960,870) between total payment DRGs/PPS and the fee by the present insurance system were period of hospital stay, treatment in the intensive care unit, complication, cancer chemotherapy, expensive surgical materials etc.

Diagnosis-Related Groups↗
PubMed1987

Effects of the prospective payment system on medical record coding.

This article reports upon a study carried out in Alabama to verify if coding functions had actually changed due to PPS as commonly perceived. The study also sought to identify the specific changes in coding procedures and in personnel requirements in that state.

Abstracting and Indexing↗
PubMed1985

Severity of illness and diagnostic formulation: classifying patients for prospective payment systems.

The authors review several methods for enhancing the clinical utility of psychiatric diagnostic formulations and their value in predicting resource consumption. They suggest incorporating the concept of severity of illness in a comprehensive diagnostic formulation, using an extended coding schema that includes a rating of severity. Other modifications of DSM-III axes are proposed.

Costs and Cost Analysis↗
PubMed1986

An alternate level of care, the prospective payment system and the challenge of extended care.

Due to demographic, morbidity and public policy shifts, the health care system is undergoing a profound change. In this unsettled context the problem of the alternate level of care (ALC), or sub-acute care, patient has acquired a new meaning and importance. An ALC patient falls between the traditional levels of acute and skilled care. This study tries to identify the nature and scope of the ALC problem in Illinois, because it is symptomatic of changing morbidity patterns; because it exemplifies the consequent dilemmas for the health care industry; and because it typifies the ambivalent response of the health care institutions. The data reveals that the ALC patients are backed up in 78% of the hospitals in the state, and they pose a heavy burden and future risk both to hospitals and nursing homes. The hospital industry has sensed the challenge of extended care, but it is not responding with a reasoned and concerted strategy. Rather, in a worsening competitive situation, a unique opportunity to bridge the hiatus between acute and long-term care, and to build towards a humane and equitable system of care, may pass us by.

Aged↗
PubMed1985

Nosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control. Economic implications for hospitals under the prospective payment system.

It is obvious that escalating costs of medical care must be curbed. Fortunately, since the major proportion of health care costs relate to inpatient management, the diagnosis-related group "experiment" forces the medical community to examine carefully the costs of the specific components of health care delivery. One such item is the cost of nosocomial infections. With respect to the potential importance of hospital-acquired infections and reimbursement under the diagnosis-related group system, several points should be underscored. Nosocomial infections represent a direct economic liability of $5 to $10 billion annually in the United States. Under the new diagnosis-related group reimbursement system, it is probable that very little of the costs related to excess stay resulting from infections will be reimbursed to hospitals. For the first time, there are data indicating that as much as one third of hospital-acquired infections can be prevented by implementing effective infection control programs. The currently available information suggests that under the existing diagnosis-related group reimbursement system, hospitals with effective infection control programs can significantly improve their economic position.

Adult↗
PubMed1992

Trends in total hospital financial performance under the prospective payment system.

In this article, the author examines trends in determinants of total hospital facility revenues, expenses, and net profits during the period 1977-89. Measures of change in transaction prices are developed, which enable an analysis of trends in real hospital outputs and total factor productivity. The main source of hospital spending growth in excess of the gross national product is identified as growth in hospital employee compensation.

Capital Expenditures↗
PubMed2006

Selection of treatment under prospective payment systems in the hospital sector.

A model of contracting for hospital treatments is presented. For a given diagnosis of the patient, two treatments are available: a high-intensity (surgical) treatment and a low-intensity (medical) treatment. A purchaser (the National Health Service, public or private insurer) offers a contract to the provider (the hospital) to maximise the patients' benefit net of costs. We show that if the average severity of the patient is private information known only by the provider, the hospital has an incentive to over-provide the surgical treatment to the low-severity patients. The optimal contract with asymmetric information is such that hospitals that provide a higher share of surgical treatments receive a higher price for the surgical treatment and a lower price for the medical treatment. This situation differs from current remuneration systems in which the price for each type of treatment is uniform. A related result is that with asymmetric information the optimal contract involves a higher transfer than with symmetric information.

Algorithms↗
PubMed1991

Effect of Medicare prospective payment system on a home health agency: changes in patient population and services provided.

Data from a large home health agency was retrospectively reviewed to determine the effect of Medicare's Diagnosis Related Group (DRG) payment system on posthospital care. Variables included demographics, diagnoses, functional ability, frequency and type of services provided, and discharge status. An increase in the provision of rehabilitation and nursing services provided in the post-DRG population was found. No negative effects on patient outcomes, such as increases in emergency room visits, rehospitalization, or death, were found.

Diagnosis-Related Groups↗
PubMed2002

[Diagnosis-related groups in psychiatry and psychotherapeutic medicine - the significance of a prospective payment system].

Diagnosis-related groups (DRGs) as a basis for funding will be introduced in Germany in 2003 with exemption for Psychiatry and Psychotherapeutic Medicine. Overall, DRGs have proven to be poor predictors of resource consumption and therefore could lead to financial harms for psychiatric or psychotherapeutic facilities. Beneath these risks, a DRG-System could be a strong incentive for further development and implementation of treatment standards. Furthermore an exemption of a DRG-System could trigger the isolation of Psychiatry and Psychotherapeutic Medicine in the medical field of acute care. Therefore DRGs should be regarded as a major challenge to strengthen the importance of the treatment of psychic disorders.

Cost-Benefit Analysis↗