Presented at the APHA Annual Meeting, New Orleans, Louisiana, October 20. First, an important dimension of the comparisons of Medicare service use between 1982-83 and 1984-85 was the duration of specific services (e.g., hospital length of stay). Increases in the role of hospital outpatient care, for example, is illustrated by the fact that the percent of surgical charges under Medicare Part B incurred in hospital outpatient settings has been increasing dramatically. The remaining four parts address different service use and outcome patterns of the subgroup of Medicare beneficiaries who have chronic disabilities. It is apparent that both rates of hospital discharge to HHA and hospital LOS prior to discharge were different between the two time periods. In our analyses, these groups were used principally to determine if overall changes in Medicare service utilization between the pre- and post-PPS periods were found for major subgroups of the disabled Medicare population, and if specific vulnerable subgroups were particularly affected by PPS. In the following, we briefly discuss five studies that addressed various dimensions of the effects of PPS on hospital utilization and outcomes of patients. One of these studies (Sager, et al., 1987) examined the impact of PPS on Medicaid nursing home patients in Wisconsin. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. Schlenker, "Case-Mix, Quality, and Reimbursement Issues and Findings from Selected Studies of Long-Term Care." Similar results were obtained after the authors excluded extended hospitalization cases from the pre-PPS sample. The DRG payment rate is adjusted based on age, sex, secondary diagnosis and major procedures performed. Third, we present findings. Fifty-six (56) medical conditions, ADLs and IADLs were used in this analysis. DRG payment is per stay. Marginally significant differences (p = .10) were detected for SNF episodes, which decreased in LOS. The first component is a description of the relation of each case-mix dimension to each of the variables selected for analysis. In the following sections, we describe the data source, the analysis plan and the statistical methods employed in this study. By termination status of SNF episodes, there was a reduction in discharge from SNFs to hospitals from 30.6 percent in the pre-PPS period to 18.0 percent in the post-PPS period. Specifically, life tables were calculated for persons who have identically the characteristics of one of the groups. In light of the importance of the landmark policy, continuing research is warranted to fully assess its effects. While a fall description of the GOM subgroup profiles are presented in Appendix C, Table 2 highlights the most significant characteristics of the four groups. The changes in nursing home death rates, which began in 1982, were also associated with a 10.3 percent decline in hospital deaths during the same period. While consistent with findings of other researchers (Krakauer, 1987, DesHamais, et al., 1987), this result appears to be counterintuitive, in light of the incentives of PPS for higher admission rates and shorter lengths of stays (Stem and Epstein, 1985). The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. Continuous Medicare Part A bills permitted a tracking of persons in the NLTCS samples through different parts of the health care system (i.e., Medicare hospital, SNF and HHA) so that we could examine transitions from acute care hospitals to subsequent experience in Medicare SNF or HHA services. 1982: 194 days1984: 199 days* Adjusted for competing risks of death and end of study. This methodology provides a more complete comparison of the patterns of changes between the pre- and post-PPS periods. The new system for prospective payment of Medicare pa-tients provided that most hospitals in the United States would be reimbursed a fixed fee for each Medicare patient. Official websites use .govA The higher mortality of this subgroup may be due to higher proportions of these individuals dying while receiving non-Medicare nursing home care or other types of services. In fact, Medicare Advantage enrollment is growing because payer, provider and patient incentives are aligned per the rules of the Medicare prospective payment system. For example, there might have been substitution between hospital and SNF care for the mildly disabled, but for the heart and lung disease patients, no differences in hospital length of stay was observed. Table 6 presents the patterns of discharge for HHA episodes. Additionally, the introduction of PPS in healthcare has led to an increase in the availability of care for historically underserved populations. DSpace software (copyright2002 - 2023). Developed in 1983, PPS in healthcare was designed to create a predictable and budget-friendly system for reimbursing hospitals for their services rather than reimbursements based on actual costs incurred by the hospital. The shifts are generally in the expected direction. It was not possible to conduct a controlled experiment, since the entire country was placed under PPS at the same time. For example, we found reductions in hospital length of stay after PPS and increased use of HHA services. They could include, for example, no services, Medicaid nursing home stays and Medicare outpatient care. HCM 345 DISCUSSION 4 Prospective v Non-Prospective Payment - Course Hero I am a relatively new student and I contacted financial aid regarding my upcoming disbursement. Statistically significant differences (p = .05) between 1982 and 1984 were detected in the hospital, length of stay for this group. How do the prospective payment systems impact operations? Specific documentation supports coding and reporting of Patient Safety Indicators (PSIs) developed by the Agency for Healthcare Research and Quality (AHRQ). There are two primary types of payment plans in our healthcare system: prospective and retrospective. Hence, the research file contained detailed patient characteristics information for two points in time, straddling the implementation of PPS, and complete Medicare Part A hospital, SNF and home health utilization and mortality information. Thus the whole distribution by case-mix type has been altered by the sorting out of service venues due to the impact of PPS. "The Early Effects of the Prospective Payment System on Inpatient Utilization and the Quality of Care," Inquiry, 24:7-16. The mortality increases that do exist are of the magnitude that could be caused by year to year changes in national mortality patterns found in Figure 1. As the entire Medicare program moves towards a risk assumption model and the financial performance of providers is increasingly put at risk, many organizations are re-engineering their data-integrity programs. This result was consistent with those of Krakauer (1987) and Conklin and Houchens (1987). Declines in hospital LOS was expected because of the PPS incentive to hospitals to become more efficient. U.S. Department of Health and Human Services In contrast to the institutionalized elderly, the noninstitutionalized elderly experienced a 7 percent decrease in the rate of hospitalization and a 13 percent decrease in the mean length of stay. ** One year period from October 1 through September 30. Table 12 presents the schedule of probabilities of hospital readmission for pre- and post-PPS periods, and the difference in probabilities between the two periods. This report presented results from a study to examine the patterns of Medicare hospital, skilled nursing facility and home health agency services before and after the implementation of the hospital prospective payment system. 1987. This helps drive efficiency instead of incentivizing quantity over quality. By creating predictability in payments, a prospective payment system helps healthcare providers manage their finances and avoid the financial strain of unexpected payments. Outcomes. PPS represents a radically different approach to paying for care than the retrospective cost-based reimbursement system it replaced. The Prospective Payment System In response to payment growth, Congress adopted a prospective payment system to curtail the amount of resources the Federal Government spent on medical care for the elderly and disabled. Operations Management questions and answers Compare and contrast the various billing and coding regulations which ones apply to prospective payment systems. First, the expected use of post-acute HHA was expected in light of PPS incentives to discharge patients to lower levels of care. The system tries to make these payments as accurate as possible, since they are designed to be fixed. The mean length of stay decreased from 16.6 days to 10.3 days after the implementation of PPS. Along with other studies, some that have been completed while others are being developed, our results are intended to provide a better understanding of the changes that result from a landmark change in Medicare policies. As these studies are completed, policy makers will have a better understanding of the effects of PPS on the provision and outcomes of various t3rpes of Medicare as well as non-Medicare services. Methods of indirect standardization were used to derive a 1985 expected overall mortality rate based on 1984 mortality rates per severity level. Compare and contrast the various billing and coding regulations First, Grade of Membership analysis was used to derive subgroups of the population according to patient characteristics, and to measure case-mix changes between the pre- and post-PPS periods.

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