Accession Number : ADA192361

Title :   Medicare: Refinement of Diagnosis Related Groups Needed to Insure Payment Equity.

Corporate Author : GENERAL ACCOUNTING OFFICE WASHINGTON DC HUMAN RESOURCES DIV

PDF Url : ADA192361

Report Date : Apr 1988

Pagination or Media Count : 54

Abstract : In fiscal year 1986, Medicare paid hospitals about $45.6 billion for inpatient hospital services. About $35 billion was paid under the Medicare prospective payment system (PPS). PPS pays hospitals a fixed, predetermined amount for each Medicare beneficiary discharged from a hospital. The amount of the payment for a beneficiary depends upon the diagnosis related group (DRG) that the patient is classified under. For PPS to work as intended it is essential that DRGs group patients with similar resource needs. Because of the importance of DRGs to PPS, GAO evaluated the DRG case classification system as a means of grouping patients for payment purposes. Specifically, GAO's objectives were to (1) measure the variations in the level of resources required to treat patients within the DRGs, (2) determine if hospitals get an equal mix of high- and low-cost patients in DRGs where a wide variation in resource requirements exists, and (3) determine if hospital characteristics, such as bed size and rural or urban location, are systematically related to whether a hospital receives patients with higher- or lower-than-average treatment costs within the DRGs.

Descriptors :   *HOSPITALS, *MEDICAL SERVICES, *FINANCIAL MANAGEMENT, BEDDING, CLASSIFICATION, DIAGNOSIS(GENERAL), LOW COSTS, PATIENTS, REFINING, REQUIREMENTS, RESOURCES, RURAL AREAS, SIZES(DIMENSIONS), URBAN AREAS, VARIATIONS

Subject Categories : Administration and Management
      Medicine and Medical Research

Distribution Statement : APPROVED FOR PUBLIC RELEASE