Achieving cost control in the hospital outpatient department.

Margaret B. Sulvetta

PubMed · 1991 · 16 citations · 7 references

Concepts

TL;DR

Outpatient spending is rapidly rising, prompting a congressional mandate to develop a prospective payment system that defines payment units and weights and requires integration with other ambulatory providers. The study proposes adopting a volume performance standard approach to manage outpatient costs. The authors find that extending diagnosis‑related groups to outpatient care is infeasible.

Abstract

The rapid growth in outpatient expenditures and the congressional mandate for development of a prospective payment system (PPS) for these expenditures are discussed. Extension of diagnosis-related groups to outpatient care is shown to be infeasible. Alternative patient classification schemes and options for defining the unit of payment and establishing weights and rates are discussed. A PPS primarily controls price and can only address volume by defining a broad unit of payment, such as an episode of care. Therefore, adoption of a volume performance standard approach could be effective. Outpatient payment policies must be integrated with those of other ambulatory care providers.

References

7