Medicaid prospective payment: case-mix increase.
South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced.
Baker
S L
SL
Department of Health Administration, School of Public Health, University of South Carolina, Columbia 29208.
Kronenfeld
J J
JJ
D000043:Abstracting and Indexing; D002585:Cesarean Section / Q000706:statistics & numerical data; D015897:Comorbidity; D003953:Diagnosis-Related Groups / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008484:Medicaid / Q000706:statistics & numerical data*; D016311:Outliers, DRG; D011247:Pregnancy; D011445:Prospective Payment System / Q000706:statistics & numerical data*; D013022:South Carolina; D013221:State Health Plans; D014481:United States