[Development of classification and payment system of in patient hospital admissions in the United States: introduction of Medicare Severity Diagnosis-Related Groups (MS-DRGs) and the Present On Admission (POA) indicator].
In the United States, from Fiscal Year 2008 (october 1, 2007-september 30, 2008), two important innovations have been introduced in health insurance program Medicare: 1) Centers for Medicare & Medicaid Services (CMS) proposes to refine the current DRG system by implementing Medicare-Severity DRGs (MS-DRGs), increasing the number of DRGs from 538 to 745. In addition, CMS has undertaken an overhaul of today's complication and comorbidity (CC) list and created up to three tiers of payment for each DRG based on the presence of: a major complication or comorbidity (MCC), a complication or comorbidity, or no complication or comorbidity; 2) the Federal Government, in compliance with the Deficit Reduction Act of 2005, has required secondary diagnosis reporting for all Medicare patients at the time of admission by a Present On Admission (POA) indicator. The authors describe the main characteristics of the new MS-DRG system and POA indicator and their potential impact on Italian Public Health system.
Maurici
Massimo
M
Dipartimento di Sanità Pubblica, Università degli Studi di Roma Tor Vergata. maurici@med.uniroma2.it
Rosati
Enrico
E
D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration*; D003953:Diagnosis-Related Groups / Q000191:economics*; D006801:Humans; D007297:Inpatients; D006278:Medicare / Q000191:economics* / Q000331:legislation & jurisprudence; D010343:Patient Admission; D011445:Prospective Payment System / Q000191:economics*; D012720:Severity of Illness Index; D014481:United States