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Author : United States. Congress. Senate. Special Committee on Aging
Publisher : Unknown
Page : 794 pages
File Size : 40,9 Mb
Release : 1986
Category : Diagnosis related groups
ISBN : LOC:00185830299
Author : Anonim
Publisher : Unknown
Page : 36 pages
File Size : 46,8 Mb
Release : 1985
Category : Medicare
ISBN : UCSD:31822027504745
Author : United States. Congress. Senate. Special Committee on Aging
Publisher : Unknown
Page : 810 pages
File Size : 48,9 Mb
Release : 1986
Category : Diagnosis related groups
ISBN : STANFORD:36105021024729
Author : Anonim
Publisher : Rand Corporation
Page : 343 pages
File Size : 44,9 Mb
Release : 1992
Category : Diagnosis related groups
ISBN : 0833012207
In 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 : Anonim
Publisher : Unknown
Page : 12 pages
File Size : 49,9 Mb
Release : 1998
Category : Hospital care
ISBN : NWU:35556029693736
Author : Stuart Guterman,Allen Dobson
Publisher : Unknown
Page : 18 pages
File Size : 47,6 Mb
Release : 1986
Category : Hospitals
ISBN : IND:32000014596664
Author : Rand Corporation
Publisher : Unknown
Page : 32 pages
File Size : 40,5 Mb
Release : 1991
Category : Diagnosis related groups
ISBN : IND:30000009572284
To 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 : Institute of Medicine,Division of Health Care Services,Committee on Improving Quality in Long-Term Care
Publisher : National Academies Press
Page : 344 pages
File Size : 53,9 Mb
Release : 2001-02-27
Category : Medical
ISBN : 9780309132749
Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.
Author : Michael J. McGinty
Publisher : DIANE Publishing
Page : 152 pages
File Size : 47,5 Mb
Release : 1993
Category : Hospital care
ISBN : 9780788110535
Examines the relationship between hospital reimbursement per discharge & the clinical quality of care received by Medicare patients before & after the implementation of the PPS in 1993-1984. Objectives were to evaluate the link between program, payments & quality & to identify characteristics of higher & lower quality hospitals for the period 1981 to 1986.
Author : United States. Congress. Senate. Committee on Finance
Publisher : Unknown
Page : 488 pages
File Size : 49,7 Mb
Release : 1986
Category : Aged
ISBN : STANFORD:36105063136373
Author : Kathleen N. Lohr
Publisher : Rand Corporation
Page : 69 pages
File Size : 46,6 Mb
Release : 1985
Category : Social Science
ISBN : 0833006533
Under 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.
Author : Robert M. Gibson,Daniel R. Waldo,Katharine R. Levit
Publisher : Unknown
Page : 32 pages
File Size : 54,5 Mb
Release : 1983
Category : Medicaid
ISBN : UOM:39015029227843
Author : United States. Congress. Senate. Committee on Finance
Publisher : Unknown
Page : 506 pages
File Size : 50,6 Mb
Release : 1986
Category : Aged
ISBN : STANFORD:36105045293409
Author : Katherine L. Kahn
Publisher : Unknown
Page : 45 pages
File Size : 42,5 Mb
Release : 1990
Category : Diagnosis related groups
ISBN : OCLC:865707779
Author : Rick Mayes,Robert A. Berenson
Publisher : JHU Press
Page : 274 pages
File Size : 42,7 Mb
Release : 2006-12-20
Category : Medical
ISBN : 9780801888878
This is the definitive work on Medicare’s prospective payment system (PPS), which had its origins in the 1972 Social Security Amendments, was first applied to hospitals in 1983, and came to fruition with the Balanced Budget Act of 1997. Here, Rick Mayes and Robert A. Berenson, M.D., explain how Medicare’s innovative payment system triggered shifts in power away from the providers (hospitals and doctors) to the payers (government insurers and employers) and how providers have responded to encroachments on their professional and financial autonomy. They conclude with a discussion of the problems with the Medicare Modernization Act of 2003 and offer prescriptions for how policy makers can use Medicare payment policy to drive improvements in the U.S. health care system. Mayes and Berenson draw from interviews with more than sixty-five major policy makers—including former Treasury secretary Robert Rubin, U.S. Representatives Pete Stark and Henry Waxman, former White House chief of staff Leon Panetta, and former administrators of the Health Care Financing Administration Gail Wilensky, Bruce Vladeck, Nancy-Ann DeParle, and Tom Scully—to explore how this payment system worked and its significant effects on the U.S. medical landscape in the past twenty years. They argue that, although managed care was an important agent of change in the 1990s, the private sector has not been the major health care innovator in the United States; rather, Medicare’s transition to PPS both initiated and repeatedly intensified the economic restructuring of the U.S. health care system.