Effects of Medicare's Prospective Payment System on the Quality of Hospital Care
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Published: 1998
Total Pages: 12
ISBN-13:
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Published: 1998
Total Pages: 12
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DOWNLOAD EBOOKAuthor: Kathleen N. Lohr
Publisher: Rand Corporation
Published: 1985
Total Pages: 69
ISBN-13: 9780833006530
DOWNLOAD EBOOKUnder the prospective payment system (PPS) introduced in 1983, hospitals are to be paid for each Medicare admission on the basis of a price per case set in advance, thus giving hospitals and other providers incentives for delivering care that are radically different from those of cost-reimbursement financing. This report identifies major issues relating to quality of care, sketches conceptual and practical aspects of carrying out appropriate studies of these issues, and outlines a quality-of-care research agenda. It emphasizes changes in hospital care that are most likely to occur secondary to PPS, those likely to have the most direct impact on patients' outcomes, and changes that can be defined, detected, and measured with relative ease. Certain themes for future research efforts are stressed: (1) the overall research agenda must be strong enough to detect clinically meaningful impacts on patient outcomes and to be able to assign those impacts to PPS; (2) outcomes other than death must be examined; (3) interpreting the impacts of PPS requires understanding the clinical circumstances of Medicare patients; (4) developing better outcome measures is essential; (5) targeting impact studies on high-priority topics will be unavoidable; and (6) a full picture of the effects of PPS requires a long-term perspective, extending beyond FY 1987.
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Publisher:
Published: 1985
Total Pages: 44
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DOWNLOAD EBOOKAuthor: United States. Congress. Senate. Special Committee on Aging
Publisher:
Published: 1986
Total Pages: 794
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DOWNLOAD EBOOKAuthor: Rand Corporation
Publisher:
Published: 1991
Total Pages: 32
ISBN-13:
DOWNLOAD EBOOKTo control rising health care costs, the federal government, in 1983, established a prospective payment system (PPS) to reimburse hospitals for inhospital care of Medicare patients. PPS changed the way Medicare reimbursed hospitals from a cost or charge basis to a prospectively determined fixed-price system in which hospitals are paid according to the diagnosis-related group (DRG) into which a patient is classified. This report constitutes the executive summary of an evaluation of the impact of the DRG-based PPS system. Six conditions were selected for the evaluation: congestive heart failure, acute myocardial infarction, hip fracture, pneumonia, cerebrovascular accident, and depression. The authors used both explicit and implicit measures to assess quality of care. Two key policy conclusions emerge from the findings: (1) at least through the middle of 1986, PPS did not interrupt a long-term trend toward better hospital care; and (2) PPS has had a detrimental effect on patients' stability at discharge. The authors recommend that physicians, hospitals, and professional review organizations undertake a more systematic assessment of a patient's readiness to leave the hospital, and that clinically detailed data on sickness at admission, processes, discharge status, and outcomes continue to be collected regularly as long as PPS is in place.
Author:
Publisher:
Published: 1986
Total Pages: 132
ISBN-13:
DOWNLOAD EBOOKAuthor: Stuart Guterman
Publisher:
Published: 1986
Total Pages: 18
ISBN-13:
DOWNLOAD EBOOKAuthor: RAND Health Program
Publisher:
Published: 1998
Total Pages: 1
ISBN-13:
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Publisher: Rand Corporation
Published: 1992
Total Pages: 343
ISBN-13: 9780833012203
DOWNLOAD EBOOKIn 1983, in an effort to control rising health care costs, the federal government established a prospective payment system (PPS) to reimburse hospitals for inhospital care of Medicare patients. Under PPS, hospitals are paid an amount based largely on flat rates per admission calculated for each of approximately 470 diagnosis-related groups (DRGs). This new payment system has been somewhat successful at slowing the upward spiral of Medicare costs. However, because PPS presents incentives to decrease lengths of stay and to substitute lower-cost services and procedures, patients, physicians, and policymakers are concerned that, despite the introduction of monitoring by professional review organizations, the quality of health care given Medicare patients may have declined under PPS. This report assesses the quality of inhospital care for Medicare patients age 65 and over, before and after the implementation of PPS, and estimates the effects of the PPS intervention on quality of care, by comparing quality of care now with the best estimate of what it would have been without PPS. Specifically, the authors describe the study's design, sampling, and fieldwork; discuss changes in sickness at admission following the introduction of PPS; consider measurements of the quality of care using explicit criteria before and after implementation of the PPS; compare changes in quality of care between 1981 and 1986 for five diseases as measured by implicit review; and discuss PPS and impairment at discharge.
Author: United States. Congress. Senate. Committee on Finance
Publisher:
Published: 1986
Total Pages: 506
ISBN-13:
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