PubMed · 1991 · 16 citations · 7 references
ManagementHealth Care ManagementHealth Services AdministrationHealth Care FinanceHealth Care FinancingHealthcare AdministrationAmbulatory Care UtilizationHealthcare Cost AnalysisHospital EconomicsHospital FinancingHospital ReimbursementValue-based CareAmbulatory Care ModelsDiagnosis-related Group Payment RatesDiagnosis-related Group ReimbursementHospital Outpatient Prospective PaymentOutpatient Care CostsOutpatient Payment PolicyOutpatient Prospective Payment SystemOutpatient Reimbursement
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.
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.
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Resource-Based Relative Values
William C. Hsiao · JAMA · 1988 · 270 citations
Thomas G. McGuire, Karen Davis, Gerard F. Anderson et al. · Journal of Risk & Insurance · 1991 · 77 citations
Health Professions, Health Policy, Health Services Administration +9
Medicare's hospital payment system: is it working?
Louise B. Russell · PubMed · 1989 · 56 citations
Public Affairs, Health Policy, Health Services Administration +15
Paul M. Tenan, Herbert H. Fillmore, B Caress et al. · Journal of Ambulatory Care Management · 1988 · 34 citations
Social Sciences, Communication, Speech-language Pathology +13