title: Redesigning Medicare inpatient PPS to adjust payment for post-admission complications.
abstract: 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.
authors.affiliation: 3M Health Information Systems, Wallingford, CT 06492, USA. rfaverill@mmm.com
authors.forename: Richard F
authors.initials: RF
authors.lastname: Averill
authors.forename: James C
authors.initials: JC
authors.lastname: Vertrees
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: McCullough
authors.forename: John S
authors.initials: JS
authors.lastname: Hughes
authors.forename: Norbert I
authors.initials: NI
authors.lastname: Goldfield
mesh_terms: 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