Critical appraisal of the DRG system: problem areas for DRG reimbursement in the USA.
One may conclude that the prospective payment system known as Diagnosis Related Groups is the initial thrust of the government to reduce the rate of expenditures for Medicare patients in the acute hospital setting. More will come and probably soon. Among the criticism and concern, one must not ignore the non-inclusion of the physician provider in this system. Cost shifting to the private payer will probably result in DRGs in that area also. Concern about the ability to provide the technology necessary to render quality care is utmost on the minds of providers. The shift of patients into the alternate health care field will leave hospitals with fewer patients who are overall much sicker and the hospital will have fewer dollars from which to provide that care. There is specific criticism of some of the DRG groupings and concern with the way in which physicians will be brought under the system. The issue of bad debts and care for the indigent must be addressed. A great deal of attention must be paid in the manner in which capital costs are reimbursed. Medical education costs must be satisfactorily addressed on a national basis. MEDPAR data used to provide data base for determining the DRG rates, must be upgraded to bring fairness to the system. Now medical technology must be examined quickly and the costs of those desirable technological advances incorporated into the DRG rate so as not to impede their use. Perhaps the greatest concern relates to the factors which will be incorporated into the rate basis and those which affect the allowable rate increases.(ABSTRACT TRUNCATED AT 250 WORDS)
D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D005069:Evaluation Studies as Topic; D005376:Financial Management; D005377:Financial Management, Hospital; D005102:Health Expenditures; D006801:Humans; D008331:Management Information Systems; D011366:Professional Review Organizations; D011445:Prospective Payment System / Q000592:standards*; D011907:Rate Setting and Review; D012051:Reimbursement Mechanisms / Q000592:standards*; D014481:United States