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Results for “Prospective Payment System”

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PubMed1990

How the medicare prospective payment system affects psychiatric patients treated in short-term general hospitals.

This study's purpose was to monitor changes in hospital utilization and discharge patterns for a large national sample of Medicare psychiatric patients treated in short-term general hospitals from 1980 through 1987. We compare data on the Medicare sample with trends for psychiatric patients with Blue Cross or private health insurance who were treated in the same hospitals. Study results indicate that treatment patterns changed for the Medicare psychiatric patients. Average length of stay decreased, especially for patients treated in scatterbeds. The proportion of patients discharged to other hospitals increased, and the number of admissions dropped for those patients over age 75.

Aged↗

PubMed1988

Did Medicare's prospective payment system cause length of stay to fall?

It is well accepted that the Medicare Payment System caused average length of stay in United States hospitals to fall, but these calculations have been based on patients in short-stay, acute care hospitals. If one considers all patients covered by Medicare, length of stay rose between 1981 and 1984, although the 1985 value was below the 1981 value. The proximate cause was a marked increase in the proportion of patients staying more than 60 days in the hospital. The data are consistent with a shift of such patients from short-stay, acute care hospitals to other, exempt hospitals and units.

Data Collection↗

PubMed1985

A qualitative assessment of the Medicare prospective payment system.

This paper employs commonly accepted criteria to evaluate the potential outcomes of the Medicare pricing mechanism. The analysis suggests that the recent revisions in the Medicare payment system have less potential to contain increases in total hospital costs than those embodied in all-payer systems. In addition, this paper also suggests that the pricing mechanism will jeopardize the financial viability of many hospitals while exacerbating inequities that emanate from differential pricing policies. Finally, when viewed from the perspective of insured beneficiaries, it is reasonable to expect that the payment mechanism will reduce not only access to inpatient care but also the use of service once admitted.

Diagnosis-Related Groups↗

PubMed1988

Impact of Medicare's prospective payment system and the farm crisis on the health care of the elderly: a case study.

The spectrum of health care for the rural elderly has been negatively affected by recent changes in Medicare reimbursement policies and by the farm crisis. This case study examined the effects of these changes on the ability of rural hospitals, the aging network, and care-givers to provide adequate and continuous care to the elderly. In this case study, three gaps in services were found: a lack of programs designed to meet the needs of terminally ill patients and their families; a lack of education during the crucial transitional period between hospital discharge and home; and a lack of services and programs for the chronically-ill older adult. More studies are needed to determine if similar service gaps will be found in other rural communities. If so, public attention should be focused on possible solutions.

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PubMed1991

Medicare program; mid-year FY 1991 changes to the inpatient hospital prospective payment system--HCFA. Final rule with comment period.

This final rule with comment period implements several provisions of section 4002 of the Omnibus Budget Reconciliation Act of 1990 (Pub. L. 101-508) that affect Medicare payment for inpatient hospital services and that take effect with discharges occurring on or after January 1, 1991. The provisions of section 4002 of Public Law 101-508 affect the following: The standardized amounts, the hospital wage index, rural counties whose hospitals are deemed urban, and hospitals that serve a disproportionate share of low income patients.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1992

Multiple significant trauma diagnosis related groups: analysis and national projections based on the first year in an all-payor prospective payment system.

To assess the effect of diagnosis related group (DRG) changes on reimbursement for trauma care in New York State (NYS), 840 trauma patients were studied over a 2-year period. Average costs increased moderately ($10,338 vs. $11,646) while average revenues increased dramatically ($6,934 vs. $9,115), leading to a 21% reduction in operating losses ($1,310,625 vs. $1,032,733). This was largely a result of new multiple significant trauma (MST) DRGs. The impact of 1990/1991 DRG changes was assessed; a 39% reduction in operating losses occurred. Regression analysis of 1989 DRG case weight on cost indicated that MST DRGs were better predictors of resource utilization than other trauma DRGs. Review of NYS data affirmed that only 10% of trauma patients were assigned MST DRGs and 63% of trauma patients were discharged from community hospitals. On a national level, the effect of the new Medicare MST DRGs would be minimal, since only 5% of Medicare patients were assigned MST DRGs. Although improvements have been made, reimbursement for trauma care must be addressed further.

Adolescent↗

PubMed1993

The impact of the prospective payment system: perceived changes in the nature of practice and clinical education.

BACKGROUND AND PURPOSE: Health care financing for teaching hospitals has undergone significant change in the past decade. This report describes changes in physical therapy practice and clinical education in three New England hospitals from 1984 to 1988. SUBJECTS: Hospital administrators, physical therapy managers, and clinical educators (N = 18) from the three teaching hospitals participated in this descriptive study. METHODS: Demographic, environmental, and participant interview data were gathered and examined to identify changes during this period. RESULTS: Perceived changes in practice include growth in specialized knowledge; increased emphasis on health care quality, efficiency, and accountability; new ethical dilemmas for practitioners; and a changing physical therapy role with new professional development opportunities. Perceived changes associated with clinical education were increased student performance expectations, unchanged resources for clinical education, greater emphasis on student self-directedness, and continued high valuing of this setting for physical therapy clinical education. CONCLUSION AND DISCUSSION: These results indicate significant change in the role of the physical therapist within these settings and suggest how these changes influence the clinical education of physical therapy students in these teaching hospitals.

Clinical Competence↗

PubMed2000

Comparison of appendectomy medical expense and clinical outcome between fee for service and prospective payment system.

Since the introduction of national health insurance on March 1st 1995 in Taiwan, another 9 items (including appendectomy) were introduced into the Taiwan/prospective payment system (T/PPS). The modified T/PPS was based on those complicated appendectomy cases with secondary diagnosis or second operation where a total fee over 37,500 New Taiwan (NT) dollars was paid by National Health Insurance Bureau (NHIB) according to the real cost. The T/PPS was implemented in October 1997 due to the continuously increasing financial burden of medical expenses on the NHIB. The purpose of this study is (1) to compare the length of stay (LOS) and total medical expense of appendectomy of fee for service (FFS) and T/PPS and (2) to compare the clinical outcome of wound healing after discharge of the two systems by telephone interview. Our study investigated 100 consecutive appendectomy cases under FFS payment system and 99 consecutive appendectomy cases under T/PPS. We retrospectively analyzed LOS, operation time, and hospital cost of different items through chart review and computer data. Our results revealed that the LOS and operation time of T/PPS were significantly shorter than those of FFS (both p < 0.01). The total hospital cost, fee for room service, treatment, pharmacy, examination and anesthesia in T/PPS were also significantly less than those in FFS (all p < 0.01, except for anesthesia p < 0.05). There existed positive correlation between total hospital cost and LOS, operation time, fee for room service, treatment, pharmacy, examination and anesthesia both for T/PPS and FFS. To evaluate the clinical outcome of appendectomy between T/PPS and FFS, we interviewed 73 T/PPS cases and 73 FFS cases by telephone and chart review. Our results revealed that there were no significant differences in frequencies of having painful incision, clear incision wound on the day of discharge, and removal of stitches at hospital (p all > 0.05). We concluded that compared to FFS, T/PPS can decrease LOS and total hospital cost of appendectomy, and T/PPS's clinical outcome of appendectomy in T/PPS showed no significant difference from that in FFS.

Adult↗

PubMed1990

Physicians' patient load per DRG, the consumption of hospital resources, and the incentives of the DRG prospective payment system.

From 1985 through 1987, the authors assessed the relationship between two main variables at a large academic medical center: (1) the numbers (high or low) of patients per diagnosis-related group (DRG) treated by individual physicians and (2) hospital resource consumption of the patients. The patients were classified according to their routes of admission (emergency or non-emergency); the physicians with eight or more patients per DRG were labeled "high-patient-load physicians" (hereafter called "high-load physicians"), and those with five or fewer patients were labeled "low-patient-load physicians," ("low-load physicians"). The resource variables studied were length of stay (LOS) and total hospital cost. For the non-emergency admissions, the low-load physicians' patients had an average LOS that was 56.2% greater and an average hospital cost that was 58.3% greater than were the LOS and cost of the patients of the high-load physicians. (Both LOS and cost per patient were adjusted for DRG weight index.) This was due in part to a greater severity of illness for the patients (as measured by total ICD-9-CM codes per patient) of the low-load physicians. For the emergency admissions, the low-load physicians' patients had an average LOS that was 9.5% greater and an average hospital cost that was 10.5% greater than the LOS and cost of the patients of the high-load physicians. As in the non-emergency admissions group, severity of illness for the patients of the low-load physicians was greater. The only category of patients that was economically profitable to the hospital was the non-emergency admissions group treated by the high-load physicians. Even though these findings were the result of many factors (discussed in the text), they suggest a relationship between hospital resource consumption and the physicians' patient load per DRG.

Academic Medical Centers↗

PubMed1987

Changes in CT utilization between 1981 and 1984: implications for Medicare payment for MR imaging under the prospective payment system.

In the absence of data on current or likely patterns of use of magnetic resonance (MR) imaging, use of computed tomography (CT) at one institution in 1981 and 1984 was analyzed to provide data relevant to current federal deliberations regarding Medicare payment for inpatient MR imaging. Between 1981 and 1984 inpatient CT utilization increased 59%, primarily due to a 265% increase in body CT. In 1984 inpatients who underwent at least one CT procedure were as likely to undergo more than one procedure as to undergo only one. CT procedures were performed in a high proportion of diagnosis-related groups (DRGs), with more than one-half of head CT procedures performed in non-neurologic DRGs. Given the similarities between clinical applications of CT and MR imaging, these findings regarding CT utilization have the following implications: (a) a delay in recalibration of DRG payment rates may not take account of expected growth in utilization of MR imaging, (b) a DRG "add-on" for MR imaging should reflect the likelihood that more than one MR imaging procedure will be performed in many hospitalizations, and (c) adjustments in DRG payments for MR imaging should not be limited to the 35 neurologic DRGs.

Costs and Cost Analysis↗

PubMed1985

Surgonomics: the identifier concept. Hospital charges in general surgery and surgical specialties under prospective payment systems.

Surgical care is entering a new payment era for inhospital care using the diagnostic related group (DRG) mechanism for Medicare. A study at The Long Island Jewish-Hillside Medical Center showed that a majority of its surgical DRGs would be unprofitable under the proposed reimbursement scheme. This study was undertaken to develop a method of allowing the hospital to group patients with each DRG that would show a difference in hospital charges and be clinically meaningful to surgeons. The study implementors tested the hypothesis that entities called identifiers, arbitrarily chosen as mode of admission [emergency (+ER vs. nonemergency (-ER)] and presence (+T) or absence (-T) of blood transfusion, would show a difference in charges (mean hospital charge exclusive of physician fees) within a DRG. Nine hundred five patients in nine DRGs encompassing general surgery, thoracic surgery, cardiac surgery, neurosurgery, orthopedics, urology, and head and neck surgery were studied. For ER identifier, eight of nine DRGs were found to be positive (greater than 20% difference in charges between positive and negative identifier); for T identifier, all DRGs (9) were positive. These findings demonstrate that these identifiers may enable teaching institutions to disaggregate each DRG and, in this way, propose more equitable reimbursement rates.

Blood Transfusion↗

PubMed1986

Medicare's prospective payment system for hospitals: the impact on nursing home quality.

How are changes in Medicare affecting the quality of long term care? Finding an answer to this question is made difficult by the many variables that must be considered and the lack of concrete data on the subject. The variables include the care requirements of Medicare patients being discharged from hospitals to nursing homes, the availability and accessibility of skilled-care beds, the trends in utilization of skilled-care beds, and the capability of nursing homes to provide the care required by these patients. Anecdotal data suggest that Medicare patients are being discharged from hospitals earlier, sicker, and with more complex skilled nursing requirements than before the implementation of prospective payment, that there has been limited collaboration among hospitals and nursing homes during this period of transition in the Medicare system, and that nursing home administrators and staffs are increasingly concerned about the actual cost of providing care to a sicker group of patients and about the qualifications of staff to meet more complex care needs. One positive outgrowth of this situation is an increase in collaboration among hospitals and nursing homes. Nursing home staff are now more apt to visit a patient in the hospital to perform a preadmission assessment. Such collaboration can help avoid inappropriate nursing home admissions and improve continuity of care for patients who are admitted.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1991