Sources of financial pressure and up coding behavior in French public hospitals

Georgescu, Irène; Hartmann, Frank

doi:10.1016/j.healthpol.2013.02.003

Cited by 20 publications

(13 citation statements)

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“…If nonfor-profit managers instilled a strong ethical norm (Horwitz, 2003), and these standards could extend to conservative billing practices, then it may explain why non-for-profit institutions upcode less than for-profit hospitals. Georgescu and Hartmann (2013) This upcoding has direct positive effect on the payment received by the hospital.…”

Section: -----------------------mentioning

confidence: 99%

From downcoding to upcoding: DRG based payment in hospitals

Milcent

2020

Int J Health Econ Manag.

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A prospective disease group-based payment is a reimbursement rule used in a wide array of countries. It turns to be the hospital's payment rule to imply. The secret of this payment is a fee payment as well as a hospital's activity based payment. There is a consensus to consider this rule of payment as the least likely to be manipulated by the actors. However, the defined fee per group depends on recorded information that is then processed using complex algorithms. What if the data itself can be manipulated? The result would be a fee per group based on manipulated factors that would lead to an inefficient budget allocation between hospitals. Using a unique French longitudinal database with 145 million stays, I unambiguously demonstrate that the implementation of a finer classification led to a up-coding. The end result has been a budget transfer from public non-research hospitals to for-profit hospitals. This budget reallocation did not correspond to any change in the actual production of care. Résumé Les établissements hospitaliers français sont tous tarifés par Groupe Homogène de Séjours (GHS) depuis 2008. Ce mode de tarification est aujourd'hui largement adopté par l'ensemble des pays de l'OCDE. Toutefois, une tarification à 100% par forfait par séjour fait aujourd'hui débat en France. Les indicateurs de qualité semblent orthogonaux à la rémunération définie. Afin de prendre en compte plus finement la sévérité des patients, la classification des GHS a été multipliée par 3. A partir d'une base de données originale de 145 millions d'observations, nous sommes à même de comparer le comportement de codage avant la mise en place de cette nouvelle classification et après la mise en place de cette nouvelle classification. Nous montrons que les établissements de santé se sont adaptés à cette nouvelle classification en changeant leur From downcoding to upcoding: DRG based payment in hospitals Carine Milcent (CNRS-PSE) 2 comportement de codage. Ce changement de codage est intervenu sans modification de la production réel de soins. Suivant le type d'établissement, l'adaptation au codage diffère. La tarification étant à enveloppe fermée, nous montrons une réallocation du budget vers les établissements à but lucratifs au détriment des établissements publics hors établissements de recherche. key findings/implications of the manuscript 1-implementation of a finer classification led to a up-coding 2-At short term, a budget transfer from public non-research hospitals to for-profit hospitals 3-This budget reallocation did not correspond to any change in the actual production of care

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Section: -----------------------mentioning

confidence: 99%

From downcoding to upcoding: DRG based payment in hospitals

Milcent

2020

Int J Health Econ Manag.

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“…In France, the up‐coding of medical ailment into a DRG benefiting from a higher compensation rate or to a higher severity level was found in 65% of patient surgical files . Work pressure was found to be a relevant predictor of physician inclination to engage in DRG up‐coding …”

Section: Physician's Criticismmentioning

confidence: 99%

“…51 Work pressure was found to be a relevant predictor of physician inclination to engage in DRG up-coding. 52 In response, the government recently pledged, at least in public discourse, to instill a new impetus into a moribund health democracy. The emphasis is now on transversality (or coordination) of care between hospitals, the medico-social sector and primary care providers (eg, family physician and general practitioners).…”

Section: Physician's Criticismmentioning

confidence: 99%

Technocratic recentralization in the French health care system: A critical evaluation

Simonet

2019

Health Planning & Management

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Summary The French health care system implemented several corporate management recipes such as diagnostic‐related groups (DRGs), benchmarking, and activity‐based management in a bid to restore fiscal discipline and to “reassert the center.” The government also regrouped health policy decisions with the Regional Health Agencies and opted for a top‐down line of command to ensure policy implementation. Though reforms emphasized evidenced‐based policy and outputs measurement, outcomes were below expectations in many areas and led to a shift in values. Professional autonomy and patient engagement receded. This leads us to a critical evaluation of the French audit society.

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“…Enfin, ces études ont indiqué que la pression financière interne pouvait également donner lieu à des tensions de rôles et à des comportements de manipulation de données (Georgescu et Hartmann, 2013) ou encore à une diminution de l'implication affective des médecins envers leur organisation (Georgescu et Commeiras, 2012) . Si la majorité des chercheurs (Argyris, 1953;Hopwood, 1972;Otley, 1978) se sont concentrés sur les effets attitudinaux et comportementaux de la mesure de la performance peu d'entre eux ont étudié les antécédents de la pression financière interne .…”

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Feedback centré sur une facette de la performance et pression financière interne dans le cadre de la réalisation d’une tâche complexe : une étude dans les hôpitaux publics français

Georgescu

Augé

Grima

et al. 2019

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Tous droits réservés © Management international / International Management / Gestión Internacional, 2018 Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y compris la reproduction) est assujettie à sa politique d'utilisation que vous pouvez consulter en ligne. https://apropos.erudit.org/fr/usagers/politique-dutilisation/ Cet article est diffusé et préservé par Érudit.Érudit est un consortium interuniversitaire sans but lucratif composé de l

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Sources of financial pressure and up coding behavior in French public hospitals

Cited by 20 publications

References 19 publications

From downcoding to upcoding: DRG based payment in hospitals

From downcoding to upcoding: DRG based payment in hospitals

Technocratic recentralization in the French health care system: A critical evaluation

Feedback centré sur une facette de la performance et pression financière interne dans le cadre de la réalisation d’une tâche complexe : une étude dans les hôpitaux publics français

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