Abstract
We assessed impacts of the Medicare Prospective Payment System (PPS) during its first two years of operation (1984-85) on 467 hospitals using data from the Commission on Professional and Hospital Activities and from the American Hospital Association. Medicare discharges as a per cent of total discharges remained constant between 1983 and 1985, but the per cent of uninsured patients increased, especially at large public hospitals. The number of Medicare and total discharges per hospital declined. The number of complex diagnosis related groups (DRGs) increased, both for Medicare and non-Medicare. This trend began before the implementation of PPS and affected all types of hospitals. There was also an appreciable increase in case mix types of hospitals. There was also an appreciable increase in case mix severity within specific DRGs during 1980-85. The proportion of total patients received from or transferred to other hospitals rose after 1983, but these increases were very small. The per cent of Medicare patients admitted through the emergency room increased, especially after 1983. By contrast, the share of total non-Medicare admissions through the emergency room (ER) remained stable. Although the growth of the number of uninsured and Medicare patients admitted through the ER predate PPS, they may be influenced by it and warrant further monitoring.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ament R. P., Kobrinski E. J., Wood W. R. Case mix complexity differences between teaching and nonteaching hospitals. J Med Educ. 1981 Nov;56(11):894–903. doi: 10.1097/00001888-198111000-00003. [DOI] [PubMed] [Google Scholar]
- Coulton C. J., McClish D., Doremus H., Powell S., Smookler S., Jackson D. L. Implications of DRG payments for medical intensive care. Med Care. 1985 Aug;23(8):977–985. doi: 10.1097/00005650-198508000-00005. [DOI] [PubMed] [Google Scholar]
- Ginsburg P. B., Carter G. M. Medicare case-mix index increase. Health Care Financ Rev. 1986 Summer;7(4):51–65. [PMC free article] [PubMed] [Google Scholar]
- Guterman S., Dobson A. Impact of the Medicare prospective payment system for hospitals. Health Care Financ Rev. 1986 Spring;7(3):97–114. [PMC free article] [PubMed] [Google Scholar]
- Pettengill J., Vertrees J. Reliability and validity in hospital case-mix measurement. Health Care Financ Rev. 1982 Dec;4(2):101–128. [PMC free article] [PubMed] [Google Scholar]
- Relman A. S. Economic considerations in emergency care. What are hospitals for? N Engl J Med. 1985 Feb 7;312(6):372–373. doi: 10.1056/NEJM198502073120610. [DOI] [PubMed] [Google Scholar]
- Schiff R. L., Ansell D. A., Schlosser J. E., Idris A. H., Morrison A., Whitman S. Transfers to a public hospital. A prospective study of 467 patients. N Engl J Med. 1986 Feb 27;314(9):552–557. doi: 10.1056/NEJM198602273140905. [DOI] [PubMed] [Google Scholar]
- Wrenn K. No insurance, no admission. N Engl J Med. 1985 Feb 7;312(6):373–374. doi: 10.1056/NEJM198502073120611. [DOI] [PubMed] [Google Scholar]