Redesigning Medicare inpatient PPS to adjust payment for post-admission complications.
Under the Medicare diagnosis-related group (DRG) based inpatient prospective payment system (IPPS), payments to hospitals can increase when a post-admission complication occurs. This article proposes a redesign of IPPS that reduces, but does not eliminate, the increase in payment due to post-admission complications. Using California data that contained a specification of whether each diagnosis was present at admission, and applying a conservative approach to identifying potentially preventable complications, the impact of post-admission complications on DRG assignment was determined. Based on the redesigned IPPS, the increase in Medicare payments due to post-admission complications was reduced by more than one billion dollars annually.
Averill
Richard F
RF
3M Health Information Systems, Wallingford, CT 06492, USA. rfaverill@mmm.com
Vertrees
James C
JC
McCullough
Elizabeth C
EC
Hughes
John S
JS
Goldfield
Norbert I
NI
D003953:Diagnosis-Related Groups; D006801:Humans; D007049:Iatrogenic Disease; D007297:Inpatients; D006278:Medicare / Q000458:organization & administration*; D011445:Prospective Payment System; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D014481:United States