Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Prospective Payment System”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 109 records · Page 6Linked to original sources
PubMed1986

Coronary angioplasty under the prospective payment system: the need for a severity-adjusted payment scheme.

To evaluate the adequacy of Diagnosis Related Group prospective payment for percutaneous transluminal coronary angioplasty, the clinical characteristics, length of stay and hospital charges of all patients undergoing this procedure at Boston's Beth Israel Hospital during a 100 day period were examined. Of 113 such patients, the 61 patients in whom nonelective dilation was performed for unstable or postinfarction angina had a significantly greater length of stay and total hospital charge (10 +/- 6 days and $14,700 +/- $7,400, respectively) than did the 52 patients in whom elective dilation was performed (6 +/- 5 days and $8,500 +/- $7,700, respectively, p less than 0.0001). Under the current prospective payment system, however, these two groups of patients would have been placed in the same Diagnosis Related Group, and would have thus commanded equal institutional reimbursement. One potential revision of the payment system is presented to help to deal with this disparity.

Adult↗
PubMed1987

The impact of Medicare's prospective payment system on Wisconsin nursing homes.

To assess the impact of Medicare's prospective payment system (PPS) on nursing homes, we reviewed hospitalization and mortality data for Wisconsin's Medicaid and general elderly populations. During the 12 months following implementation of the PPS, Wisconsin's institutionalized elderly Medicaid population experienced a 72% increase in the rate of hospitalization and a 26% decline in hospital length of stay. Two explanations for the increased hospitalization include physician manipulation of the PPS and increased rehospitalization of nursing home residents who may have been discharged prematurely from hospitals. Between 1982 and 1985, analysis of mortality data revealed a 26.2% increase in the rate of deaths occurring in nursing homes. The increase in nursing home deaths began in 1983 and was associated with a 10.3% decline in hospital deaths during the same period. Using a series of logistic analyses, the shift in location of death from hospitals to nursing homes was found to be more pronounced after implementation of the PPS. This change in location of death may reflect both a less aggressive use of hospital resources by physicians caring for terminally ill patients and a transfer of seriously ill patients to nursing homes for terminal care.

Aged↗
PubMed2000

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2001 rates. Health Care Financing Administration (HCFA), HHS. Final rule.

We are revising the Medicare hospital inpatient prospective payment system for operating costs to: implement applicable statutory requirements, including a number of provisions of the Medicare, Medicaid, and State Children's Health Insurance Program Balanced Budget Refinement Act of 1999 (Pub. L. 106-113); and implement changes arising from our continuing experience with the system. In addition, in the Addendum to this final rule, we describe changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes apply to discharges occurring on or after October 1, 2000. We also set forth rate-of-increase limits and make changes to our policy for hospitals and hospital units excluded from the prospective payment systems. We are making changes to the policies governing payments to hospitals for the direct costs of graduate medical education, sole community hospitals and critical access hospitals. We are adding a new condition of participation on organ, tissue, and eye procurement for critical access hospitals that parallels the condition of participation that we previously published for all other Medicare-participating hospitals. Lastly, we are finalizing a January 20, 2000 interim final rule with comment period (65 FR 3136) that sets forth the criteria to be used in calculating the Medicare disproportionate share adjustment in reference to Medicaid expansion waiver patient days under section 1115 of the Social Security Act.

Economics, Hospital↗
PubMedDate not supplied

[Home care medicare prospective payment system and HHRg (Home Health Resource Groups)].

In 1999 USA Medicare started a prospective payment system for home care. The model is based upon the OASIS data set (Outcome and Assessment Data Set) which allows the gathering of basic data and their classification in HHRG groups (Home Health Resource Groups). The program allows a structured monitoring of the outcomes of care and a basic control of complex systems such in home care. It thus represent a model for the governance of home care services which are playing a role of increasing importance in modern health care systems.

Aged↗
PubMed2004

[Prospective payment system of medical cost and surgical cancer treatment].

The process of introducing a prospective payment system after DRG or DPC in Japan was reviewed. The effect of DPC/PPS on surgical practice was discussed. Many problems resulted in the USA by introducing the DRG/PPS system. The rapid introduction of DPC/PPS in Japan only to reduce the total medical costs may bring about undesirable results for cancer patients.

Critical Pathways↗
PubMed1993

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1994 rates; correction--HCFA. Final rule; correction.

In the September 1, 1993, issue of the Federal Register (FR Doc 93-21026) (58 FR 46270), we revised the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the system. Additionally, in the addendum to that final rule, we announced the prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs applicable to discharges occurring on or after October 1, 1993, and set forth update factors for the rate-of-increase limits for hospitals and hospital units excluded from the prospective payment systems. This notice corrects errors made in that document.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

The impact of the prospective payment system on the treatment of hip fractures in the elderly.

A review of 386 Medicare patients with hip fractures admitted to a private, suburban, teaching hospital from 1981 through 1987 revealed that since the implementation of the prospective payment system in 1984, average hospital stays declined from 17.0 days to 12.9 days (24.1%). Although the mean number of physical therapy sessions declined from 11.1 to 9.8 (11.7%), the average number of treatments per day during the physical therapy phase actually increased from 1.2 before to 1.4 after the prospective payment system. The proportion of patients discharged to nursing homes remained the same (52.9% vs 53.6%); the proportion of patients remaining in a nursing home 6 months after hospital discharge did not differ significantly (22.6% vs 19.9%). Furthermore, there were no differences in the 6-month ambulation status. Total adjusted average hospital charges for the pre- and post-prospective payment system groups did not increase significantly ($7295 vs $7565). These findings do not support the contention that the quality of care provided Medicare patients with hip fractures has deteriorated in this hospital environment.

Aged↗
PubMed2002

[Health economics analysis of prospective payment systems in medical rehabilitation].

The forthcoming introduction of the DRG-system as a new hospital funding system in Germany reinforced the discussion about a reform of the already existing funding system in medical rehabilitation. Experience and concepts from acute medicine, however, cannot be transferred directly to rehabilitation. The development of a patient classification system is a presupposition for prospective payment systems. Initial attempts in rehabilitation-specific patient classification systems already exist, even though a comprehensive approach is not yet noticeable. International patient classification systems scarcely seem to be transferable due to the specific German case-mix. The specific differences between acute medicine and medical rehabilitation relevant for the valuation of funding systems are analyzed. Particularly a reduction of the length of stay as a primary aim for the introduction of the DRG-system does not seem appropriate for medical rehabilitation. The existing funding system in medical rehabilitation is analyzed from an economic point of view. The cost management of the German pension insurance, being one of the rehabilitation providers in Germany, has achieved high quality standard of treatment as well as cost restriction. This funding system has been further developed during the last couple of years. Future developments are shown.

Chronic Disease↗
PubMed1988

Does one national prospective payment system market basket make sense?

For the first 4 years of Medicare's prospective payment system (PPS), one national market basket of cost weights and price proxies has been used to update payment rates. Previous evidence for a single rate is reviewed, and more recent data are presented that show definite regional differences in input price inflation, resulting in systematic gains or losses for some regions. However, as long as the Health Care Financing Administration continues to periodically update its hospital wage index, the net impact on hospitals is minor. Nevertheless, large differences in PPS-excluded hospital cost shares indicate the need for two sets of cost weights.

American Hospital Association↗
PubMed1996

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1997 rates; corrections--HCFA. Final rule; correction.

In the August 30, 1996 issue of the Federal Register (61 FR 46166), we published a final rule revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the system. In the addendum to that final rule, we announced the amounts and factors for determining prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs applicable to discharges occurring on or after October 1, 1996, and set forth rate-of-increase limits for hospitals and hospital units excluded from the prospective payment systems. This document corrects errors made in that document.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2005

The early impact of the inpatient rehabilitation facility prospective payment system on stroke rehabilitation case mix, practice patterns, and outcomes.

UNLABELLED: DeJong G, Horn SD, Smout RJ, Ryser DK. The early impact of the inpatient rehabilitation facility prospective payment system on stroke rehabilitation case mix, practice patterns, and outcomes. OBJECTIVE: To determine the early effects of the inpatient rehabilitation facility (IRF) prospective payment system (PPS) on stroke rehabilitation case mix, practice patterns, and outcomes. DESIGN: Prospective observational cohort study. SETTING: Three IRFs in the United States. PARTICIPANTS: Consecutively enrolled convenience sample of 539 stroke rehabilitation patients treated between 2001 and 2003 in 3 IRFs. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Length of stay (LOS), therapy utilization, FIM instrument gain, and discharge destination. RESULTS: The IRF-PPS had no material short-term effect on stroke rehabilitation case mix and LOS for the study facilities. Facilities shifted physical and occupational therapy resources from those in the most severe case-mix groups (CMGs) to those in the moderate CMGs. Those in the more severe CMGs also experienced a noticeable decline in FIM score gain over the course of the rehabilitation stay. Using multivariate analyses, the authors discerned no major role for the IRF-PPS in explaining pre- and post-PPS differences in utilization and outcome among study facilities. CONCLUSIONS: For the 3 study facilities, IRF-PPS did not materially reshape stroke rehabilitation case mix, utilization, and outcome in the early stages of PPS implementation, apart from the shift in therapy resources from more severely involved stroke patients to moderately involved patients. The study's findings are limited to 3 facilities, and a longer time horizon is needed to more fully determine the effects of the IRF-PPS.

Activities of Daily Living↗
PubMed1999

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 2000 rates. Department of Health and Human Services (HHS), Health Care Financing Administration (HCFA). Final rule.

We are revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement changes arising from our continuing experience with the systems. In addition, in the addendum to this final rule, we describe changes in the amounts and factors necessary to determine rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are applicable to discharges occurring on or after October 1, 1999. We also set forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the prospective payment systems. Finally, we are revising certain policies governing payment to hospitals for the direct costs of graduate medical education.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

An analysis of the Prospective Payment System's labor-nonlabor share by diagnosis-related group.

When Congress in 1983 legislated a new Prospective Payment System (PPS) for Medicare hospital payment, the payment algorithm was founded on a simplifying assumption of a constant 80-20 percentage share of labor and nonlabor costs across all diagnosis-related groups (DRGs). Using Medicare claims data and hospital cost reports, this study examines the accuracy of this assumption. While a few DRGs are found to vary significantly from the norm, a systematic cancelling out of high and low labor-intensive DRGs results in no material PPS payment bias at the hospital level. Indeed, rural hospitals, if anything, benefit by the assumption. A very small number of outlier DRGs and hospitals are troublesome, nonetheless, implying fine-tuning of the algorithm.

Diagnosis-Related Groups↗
PubMed1994

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1995 rates; correction--HCFA. Final rule; correction.

In the September 1, 1994 issue of the Federal Register (59 FR 45330), we published a final rule with comment period revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the system. In the addendum to that final rule with comment period, we announced the prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs applicable to discharges occurring on or after October 1, 1994, and set forth update factors for the rate-of-increase limits for hospitals and hospital units excluded from the prospective payment systems. This notice corrects errors made in that document.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

Medicare program; changes to the hospital inpatient prospective payment systems and rates and costs of graduate medical education: fiscal year 2002 rates; provisions of the Balanced Budget Refinement Act of 1999; and provisions of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000. Final rules.

We are revising the Medicare hospital inpatient prospective payment systems for operating and capital costs to: implement applicable statutory requirements, including a number of provisions of the Medicare, Medicaid, and SCHIP [State Children's Health Insurance Program] Benefits Improvement and Protection Act of 2000 (Public Law 106-554); and implement changes arising from our continuing experience with these systems. In addition, in the Addendum to this final rule, we describe changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes apply to discharges occurring on or after October 1, 2001. We also set forth the rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the prospective payment systems. We are making changes to the policies governing payments to hospitals for the direct costs of graduate medical education and critical access hospitals. Lastly, we are responding to public comments received on the following two related interim final rules that we published in the Federal Register and finalizing those interim rules: An August 1, 2000 interim final rule with comment period (65 FR 47026, HCFA-1131-IFC) that implemented, or conformed the regulations to, certain statutory provisions relating to Medicare payments to hospitals for inpatient services that were contained in the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106-113), and that were effective during FY 2000. These provisions related to reclassification of hospitals from urban to rural status, reclassification of certain hospitals for purposes of payment during fiscal year 2000, critical access hospitals, payments to hospitals excluded from the prospective payment system, and payments for indirect and direct graduate medical education costs. A June 13, 2001 interim final rule with comment period (66 FR 32172, HCFA-1178-IFC) that implemented, or conformed the regulations to, certain statutory provisions relating to Medicare payments to hospitals for inpatient services that were contained in Public Law 106- 554, and that were effective prior to passage of Public Law 106-554 on December 21, 2000; on April 1, 2001; or on July 1, 2001. Many of the provisions of Public Law 106-554 modified changes to the Social Security Act made by Public Law 106-113 or the Balanced Budget Act of 1997 (Public Law 105-33), or both.

Education, Medical, Graduate↗
PubMed1996

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1996 rates; corrections--HCFA. Correction to final rule.

In the September 1, 1995, issue of the Federal Register (60 FR 45778), we published a final rule with comment period revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the system. In the addendum to that final rule with comment period, we announced the prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs applicable to discharges occurring on or after October 1, 1995, and set forth update factors for the rate-of-increase limits for hospitals and hospital units excluded from the prospective payment systems. This document corrects errors made in that document.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1986

The prospective payment system: implications for therapeutic recreation.

In 1983, medicare began paying general hospitals by a prospective payment system based on diagnostically-related groupings (DRGs). The majority of therapeutic recreation settings (including psychiatric hospitals, rehabilitation centers, long-term care hospitals, and children's hospitals) have been exempted. However, in 1985, a plan and subsequent decision will be made on how to integrate these settings into this new system. This article provides an historical review of the medicare program, the rationale behind this new system, the method for implementing the DRGs, and the implications and strategies for therapeutic recreation.

Diagnosis-Related Groups↗
PubMed1998

Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1999 rates; corrections--HCFA. Final rule; correction notice.

In the July 31, 1998 issue of the Federal Register (63 FR 40,594), we published a final rule revising the Medicare hospital inpatient prospective payment systems for operating costs and capital related costs to implement applicable statutory requirements, including the Balanced Budget Act of 1997 (BBA), as well as changes arising from our continuing experience with the system. In addition, in the addendum to that final rule, we announced the amounts and factors for determining prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs applicable to discharges occurring on or after October 1, 1998, and set forth rate-of-increases limits for hospitals and hospital units excluded from the prospective payment systems. This document corrects errors made in that document.

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