Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single depar...

The 1983 amendments to the Social Security Act (Public Law 98-21) provided for a prospective payment system (PPS), effective October 1, 1983, for most short-stay hospitals certified to provide inpatient services to Medicare beneficiaries. A brief description of the assignment process for diagnosis-related groups (DRGs) is presented, because assigning a DRG code to a short-stay hospital discharg...

Until 1984, when the Deficit Reduction Act (DRA) was passed, hospitals and their clinical laboratories were fully reimbursed for nearly all test analyses that were performed. The DRA established a Medicare system that indirectly pays for laboratory tests as part of a total-care reimbursement fee based on the diagnosis-related group (DRG) that classifies the patient’s clinical condition. Under t...

Hospital readmissions receive increasing interest from policy makers because reducing unnecessary readmissions has the potential to simultaneously improve quality and save costs. This paper reviews readmission policies in Denmark, England, Germany and the United States (Medicare system). The suggested roadmap enables researchers and policy makers to systematically compare and analyse readmissio...

Introduction Percutaneous coronary interventions (PCI), like angioplasty or stents, are well established and reflected in DRG payment. However, recent scientific evidence shows that a significant number of patients having socalled intermediate stenoses (i.e., a stenosis diameter bt. 40%–70% of the total coronary calibre) do not necessarily profit from PCI. A diagnostic test – the measurement of...

Historically, Israel paid its non-profit hospitals on a perdiem (PD) basis. Recently, like other OECD countries, Israel has moved to activity-based payments. While most countries have adopted a diagnostic related group (DRG) payment system, Israel has chosen a Procedure-Related Group (PRG) system. This differs from the DRG system because it classifies patients by procedure rather than diagnosis...

Introduction: Under pathological conditions, abnormal increase in intracellular calcium concentrations is believed to induce cell death. In the present study, a voltage-sensitive calcium channel blocker (loperamide hydrochloride) was used to investigate its role in inhibition of apoptosis in sensory neurons of cultured spinal dorsal root ganglia (DRG). Methods: L5 DRG from adult rats were di...

HOSPITAL QUALITY AND MEDICARE PAYMENT:A THEORETICAL AND EMPIRICAL INVESTIGATION byJINGHUA HUANGMay 2011Advisor: Gail SummersMajor: EconomicsDegree: Doctor of PhilosophyDoes Medicare’s payment rate for a hospital stay influence thequality of care received by a patient? This question is examined,theoretically and empirically. First, a model is developed which<l...