Orthopedics coding and funding.
The French tarification à l'activité (T2A) prospective payment system is a financial system in which a health-care institution's resources are based on performed activity. Activity is described via the PMSI medical information system (programme de médicalisation du système d'information). The PMSI classifies hospital cases by clinical and economic categories known as diagnosis-related groups (DRG), each with an associated price tag. Coding a hospital case involves giving as realistic a description as possible so as to categorize it in the right DRG and thus ensure appropriate payment. For this, it is essential to understand what determines the pricing of inpatient stay: namely, the code for the surgical procedure, the patient's principal diagnosis (reason for admission), codes for comorbidities (everything that adds to management burden), and the management of the length of inpatient stay. The PMSI is used to analyze the institution's activity and dynamism: change on previous year, relation to target, and comparison with competing institutions based on indicators such as the mean length of stay performance indicator (MLS PI). The T2A system improves overall care efficiency. Quality of care, however, is not presently taken account of in the payment made to the institution, as there are no indicators for this; work needs to be done on this topic.
Service PMSI, Hôpital Avicenne, Université Paris XIII, 125, rue de Stalingrad, 93009 Bobigny Cedex, France. Electronic address: sophie.baron@avc.aphp.fr.
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Baron
Service PMSI, Hôpital Avicenne, Université Paris XIII, 125, rue de Stalingrad, 93009 Bobigny Cedex, France.
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Duclos
Service de chirurgie et traumatologique orthopédique, Hôpital Avicenne, Université Paris XIII - Arts et Métiers Paris Tech, 125, rue de Stalingrad, 93009 Bobigny Cedex, France.
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Thoreux
D059019:Clinical Coding / Q000145:classification* / Q000191:economics*; D003363:Cost Control / Q000145:classification / Q000191:economics; D003953:Diagnosis-Related Groups / Q000145:classification* / Q000191:economics*; D057286:Electronic Health Records / Q000191:economics; D005245:Fee Schedules / Q000145:classification* / Q000191:economics*; D005602:France; D005102:Health Expenditures / Q000145:classification; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008491:Medical Informatics Applications; D009313:National Health Programs / Q000191:economics*; D019637:Orthopedic Procedures / Q000145:classification* / Q000191:economics*; D011445:Prospective Payment System / Q000145:classification / Q000191:economics; D011785:Quality Assurance, Health Care / Q000145:classification / Q000191:economics
Clinical coding; Diagnosis-related groups; Orthopedics funding; PMSI medical information system; T2A prospective payment system