The incremental cost of second and third ambulatory procedures.
The discount factor applied to payments for second and subsequent ambulatory procedures in a payment system based on ambulatory patient groups (APGs) is important in determining the financial incentives of the system and the adequacy of the payment rates. A 1995 empirical study of data from all ambulatory surgery cases done in acute general hospitals in Maryland suggests that the incremental charges associated with an APG when it is a second procedure APG are about 24% of the charges that are incurred when the APG is the only procedure APG in an encounter. For the third procedure APG, the percentage drops to 16%. This 24% factor is much lower than the discount factor generally used in APG payment systems. The article presents APG-adjusted charges by payer to show differences in resource use by payer. These results will be useful for organizations developing APG-based payment systems for ambulatory surgery or desiring to use APGs for benchmarking purposes.
Atkinson
G
G
Atkinson Consulting, Washington, DC, USA.
D000556:Ambulatory Surgical Procedures / Q000145:classification* / Q000191:economics*; D019985:Benchmarking / Q000191:economics; D003953:Diagnosis-Related Groups / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data* / Q000639:trends; D006769:Hospitals, General / Q000191:economics; D006801:Humans; D008396:Maryland; D008484:Medicaid / Q000191:economics*; D012044:Regression Analysis; D012051:Reimbursement Mechanisms; D012086:Reoperation / Q000191:economics* / Q000706:statistics & numerical data; D013503:Surgery Department, Hospital / Q000191:economics; D014481:United States