title: Toward a prospective payment system for ambulatory surgery.
abstract: In this article, ambulatory surgery among the aged Medicare population in 1985 is examined. Total hospital facility charges for ambulatory surgery in that year were estimated at $1.8 billion, with about one-half of that amount involving cataract surgery. The possibility of using diagnosis-related groups for a prospective payment system for ambulatory surgery was examined and was rejected for two reasons: (1) about 20 percent of the dollar volume of hospital-based ambulatory surgery fell into medical diagnosis-related groups and (2) the ratio of inpatient diagnosis-related group weight to outpatient billed charges for the ambulatory procedures falling into a given diagnosis-related group varied more than tenfold, making diagnosis-related group weights impossible to use in a consistent manner. A newly developed version of ambulatory visit groups and the even newer ambulatory patient groups were then considered as an alternative for a prospective payment system. These are briefly described.
authors.affiliation: Heller School, Brandeis University, Waltham, MA 02254.
authors.forename: J
authors.initials: J
authors.lastname: Lion
authors.forename: J
authors.initials: J
authors.lastname: Vertrees
authors.forename: A
authors.initials: A
authors.lastname: Malbon
authors.forename: A
authors.initials: A
authors.lastname: Collard
authors.forename: P
authors.initials: P
authors.lastname: Mowschenson
mesh_terms: D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D003625:Data Collection; D003953:Diagnosis-Related Groups / Q000191:economics / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D006801:Humans; D006278:Medicare / Q000458:organization & administration*; D011445:Prospective Payment System / Q000458:organization & administration*; D011907:Rate Setting and Review / Q000379:methods*; D014481:United States