The Origins, Development, and Passage of Medicare's Revolutionary Prospective Payment System

Mayes, Rick

doi:10.1093/jhmas/jrj038

Cited by 93 publications

(65 citation statements)

References 22 publications

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“…The Centers for Medicare and Medicaid Services (CMS) operate a Prospective Payment System (PPS) to reimburse hospitals for the care of Medicare patients (Mayes (2007)). 3 Under this system, CMS reimburses hospitals for the treatment of eligible patients by predetermined amounts based on patient diagnosis (summarized by a single 3-digit DRG code) rather than on actual procedures performed.…”

Section: Hospital Reimbursement and Drg Codesmentioning

confidence: 99%

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

Powell

Savin

Savva

2012

M&SOM

116

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We study the impact of physician workload on hospital reimbursement utilizing a detailed data set from the trauma department of a major urban hospital. We find that the proportion of patients assigned a "highseverity" status for reimbursement purposes, which maps, on average, to a 47.8% higher payment for the hospital, is substantially reduced as the workload of the discharging physician increases. This effect persists after we control for a number of systematic differences in patient characteristics, condition and time of discharge. Furthermore, we show that it is unlikely to be caused by selection bias or endogeneity in either discharge timing or allocation of discharges to physicians. We attribute this phenomenon to a workloadinduced reduction in diligence of paperwork execution. We estimate the associated monetary loss to be approximately 1.1% (95% Confidence Interval 0.4% − 1.9%) of the department's annual revenue.

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Section: Hospital Reimbursement and Drg Codesmentioning

confidence: 99%

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

Powell

Savin

Savva

2012

M&SOM

116

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“…The introduction of the DRG system was in part responsible for an exodus of procedures that had traditionally been done in the hospital on an "inpatient" basis. Mayes (2007) states that, relying on advances in medical technology, many hospitals began to bridge the gap between Part A and Part B by working with physicians in outpatient facilities in an attempt to avoid whenever medically feasible the disparate reimbursement systems inherent in Parts A and B.…”

Section: The Present Day Impact On Doctors and Hospitalsmentioning

confidence: 99%

The Evolving Relationships Between Hospital, Physician and Patient in Modern American Healthcare

Garner

McCabe²

2012

hcs

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This article investigates the ways in which the relationships between patient, provider and hospital have evolved in the past fifty years, while paying special attention to the influence of modern health care reform on all parties involved. Using Medicare as the primary standard, the nation's health care system is examined both historically and in light of recent changes that seek to transition its structure from one that is cost based to an approach that emphasizes performance. It is only through understanding the roots of our health care program that we can make informed decisions designed to improve its future impact and benefit both the system and the people it seeks to serve.

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“…When first implemented in 1983, the DRG model represented a substantial shift away from traditional cost-based billing, transferring risk and potential cost-savings to hospitals [20]. Regardless of true hospital costs, all inpatient admissions under the same DRG are reimbursed using the same ''bundled'' payment, the only exception being a reimbursement modifier for either major or minor patient complications and/or comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement

Samuel

Webb

Lukasiewicz

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Medicare currently reimburses hospitals for inpatient admissions with ''bundled'' payments based on patient Diagnosis-related Groups (DRGs) regardless of true hospital costs. At present, DRG 536 (fractures of the hip and pelvis) includes a broad spectrum of patients with orthopaedic trauma, likely with varying inpatient resource utilization. With the growing incidence of fractures in the elderly, inadequate reimbursements from Medicare for certain patients with DRG 536 may lead to growing financial strain on healthcare institutions caring for these patients with higher costs. Questions/purposes The purposes of the study were to determine whether (1) inpatient length of stay; (2) intensive care unit stay; and (3) ventilator time differ among subpopulations with Medicare DRG 536. Methods A total of 56,683 patients, 65 years or older, with fractures of the hip or pelvis were identified in the 2011 and 2012 National Trauma Data Bank. This clinical registry contains data on trauma cases from more than 900 participating trauma centers, allowing analysis of resource One of the authors certifies that he (AMS) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Orthopaedic Trauma Association (Rosemont, IL). One of the authors certifies that he (JML) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from Bone Therapeutics (Charleroi, Belgium), an amount of less than USD 10,000 from Kuros (Zurich,Switzerland), an amount of less than USD 10,000 from ISTO Technologies (St Louis, MO, USA), an amount of less than USD 10,000 from Emcyte (Fort Myers, FL, USA), an amount of less than USD 10,000 from Royal Marketing Inc (Westmount, Quebec, Canada), an amount of less than USD 10,000 from Graftys (Chicago, IL, USA), an amount of USD 100,000-USD 1,000,000 from Merck (Kenilworth, NJ, USA), and an amount of USD 100,000-USD 1,000,000 from National Institutes of Health (Bethesda, MD, USA). One of the authors certifies that he (JNG) or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Bioventus (Durham, NC, USA), an amount of USD 10,000-USD 100,000 from Harvard Clinical Research Institute (Boston, MA, USA), an amount of USD 10,000-USD 100,000 from ISTO Technologies (St Louis, MO, USA), an amount of less than USD 10,000 from Medtronic (Minneapolis, MN, USA), an amount of USD 10,000-USD 100,000 from Stryker (Kalamazoo, MI, USA), an amount of less than USD 10,000 from Affinergy (Durham, NC, USA), an amount of USD 10,000-USD 100,000 from Alphatec (Carlsbad, CA), an amount of less than USD 10,000 from DePuy (Raynham, MA, USA), an amount of less than USD 10,000 from Powered Research (Research Triangle Park, NC, USA), an amount of less than USD 10,000 from KCI (San Antonio, TX, USA), an amount of less than USD 10,000...

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The Origins, Development, and Passage of Medicare's Revolutionary Prospective Payment System

Cited by 93 publications

References 22 publications

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

Physician Workload and Hospital Reimbursement: Overworked Physicians Generate Less Revenue per Patient

The Evolving Relationships Between Hospital, Physician and Patient in Modern American Healthcare

Variation in Resource Utilization for Patients With Hip and Pelvic Fractures Despite Equal Medicare Reimbursement

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