A comprehensive payment model for short- and long-stay psychiatric patients.
In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated.
Institute of Gerontology and School of Public Health, University of Michigan, Ann Arbor 48109.
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Fries
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Durance
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DR
Nerenz
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Ashcraft
D000208:Acute Disease / Q000145:classification / Q000191:economics; D003953:Diagnosis-Related Groups / Q000145:classification / Q000191:economics; D017050:Episode of Care; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000145:classification / Q000191:economics; D001523:Mental Disorders / Q000145:classification* / Q000191:economics; D015233:Models, Statistical; D011567:Psychiatric Department, Hospital / Q000191:economics*; D011907:Rate Setting and Review / Q000379:methods; D014481:United States; D014493:United States Department of Veterans Affairs