Alternative Comorbidity Adjustors for the Medicare Inpatient Psychiatric Facility PPS
نویسندگان
چکیده
The inpatient psychiatric facility prospective payment system (IPF-PPS), provides per diem payments for psychiatric hospitals and units, including 17 comorbid condition payment adjustors that cover 11 percent of patients. This study identifies an alternative set of 16 adjustors identifying three times as many high-cost patients and evaluates the improved predictive power in log per diem cost regression models. A model using the IPF-PPS adjustors achieved 8.8 percent of the feasible improvement from a no-adjustor baseline, while the alternative adjustors achieved 22.1 percent of the feasible improvement. The current adjustors may therefore be too restrictive, resulting in systematic over- or underpayment for many patients.
منابع مشابه
Hospital and Medicare financial performance under PPS, 1985-90
Although an increasing number of hospitals are reporting net losses from the Medicare prospective payment system (PPS) for inpatient care, overall hospital facility profit rates remain stable. Hospitals that reported net profits in the Medicare inpatient PPS sector in PPS 7 (1990) had smaller increases in Medicare expenses than hospitals that reported PPS losses in PPS 7. Medicare PPS inpatient...
متن کاملReport to Congress Prospective Payment System for Inpatient Services in Psychiatric Hospitals and Exempt Units
Historically, Medicare reimbursed health care facilities on the basis of costs. Cost based reimbursement methods have long been criticized because they are often complex, provide few incentives for furnishing care efficiently, and result in unpredictable payments. Because of the rapid rate of growth in outlays for inpatient hospital care, Congress first directed implementation of a prospective ...
متن کاملPatient casemix classification for medicare psychiatric prospective payment.
OBJECTIVE For a proposed Medicare prospective payment system for inpatient psychiatric facility treatment, the authors developed a casemix classification to capture differences in patients' real daily resource use. METHOD Primary data on patient characteristics and daily time spent in various activities were collected in a survey of 696 patients from 40 inpatient psychiatric facilities. Surve...
متن کاملEffects of the prospective payment system on anemia management in maintenance dialysis patients: implications for cost and site of care
BACKGROUND The 2011 expanded Prospective Payment System (PPS) and contemporaneous Food and Drug Administration label revision for erythropoiesis-stimulating agents (ESAs) were associated with changes in ESA use and mean hemoglobin levels among patients receiving maintenance dialysis. We aimed to investigate whether these changes coincided with increased red blood cell transfusions or changes to...
متن کاملPredictors of Psychiatric Boarding in the Emergency Department
INTRODUCTION The emergency psychiatric care is system is overburdened in the United States. Patients experiencing psychiatric emergencies often require resources not available at the initial treating facility and frequently require transfer to an appropriate psychiatric facility. Boarding of psychiatric patients, defined as a length of stay greater than four hours after medical clearance, is ub...
متن کامل