Evaluation of a prospective payment system for hospital-based outpatient care.
The design of a prospective payment system (PPS) for outpatient care based on ambulatory patient groups (APGs) requires numerous policy decisions to be made. The policy issues include the method of computing payment weights, the extent of ancillary packaging, the window of time for ancillary packaging, the extent of multiple procedure discounting, and the outlier policy. Financial simulations of an APG-based outpatient PPS were performed in order to evaluate the impact of alternative policy decisions. Recommendations are made relative to each policy issue.
Averill
R F
RF
3M Health Information Systems, Wallingford, CT, USA.
Goldfield
N
N
Gregg
L W
LW
Shafir
B V
BV
D000553:Ambulatory Care / Q000145:classification*; D014487:Centers for Medicare and Medicaid Services, U.S.; D003953:Diagnosis-Related Groups / Q000145:classification / Q000191:economics; D005069:Evaluation Studies as Topic; D005251:Fees, Medical; D006751:Hospital Information Systems; D007344:Insurance Claim Reporting; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D011445:Prospective Payment System / Q000592:standards*; D014481:United States