Design of a prospective payment patient classification system for ambulatory care.
The Ambulatory Patient Group (APGs) are a patient classification system that was developed to be used as the basis of a prospective payment system (PPS) for the facility costs of outpatient care. This article will review the key characteristics of a patient classification system for ambulatory care, describe the APG development process, and describe a payment model based on the APGs. We present the results of simulating the use of APGs in a prospective payment system, and conclude with a discussion of the implementation issues associated with an outpatient PPS.
3M Health Information Systems, Wallingford, CT 06492.
R F
RF
Averill
N I
NI
Goldfield
M E
ME
Wynn
T E
TE
McGuire
R L
RL
Mullin
L W
LW
Gregg
J A
JA
Bender
D000553:Ambulatory Care / Q000145:classification* / Q000191:economics / Q000706:statistics & numerical data; D000720:Ancillary Services, Hospital / Q000145:classification / Q000191:economics / Q000706:statistics & numerical data; D014487:Centers for Medicare and Medicaid Services, U.S.; D003953:Diagnosis-Related Groups / Q000145:classification*; D017050:Episode of Care; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data; D006278:Medicare / Q000458:organization & administration*; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D011445:Prospective Payment System / Q000458:organization & administration*; D014481:United States