Biomaterial Database

Good quality care increases hospital profits under prospective payment. 1992

D C Hsia, and C A Ahern

United States Department of Health and Human Services, Baltimore, MD 21207.

This study shows that, contrary to popular belief, the prospective payment system discourages skimping on medically indicated care. The quality of care on a nationally representative sample of Medicare discharges underwent judgmental review using implicit criteria. The reviewing physicians identified hospitalizations that omitted medically indicated services and diagnoses overlooked because of this skimping. After deduction for the cost of the omitted services and probability of negative diagnostic tests, good quality care would have increased hospital profits a significant 7.9 percent. As the specificity of diagnosis and intensity of treatment increase, the DRG payment rises faster than the cost of providing medically indicated services.

UI	MeSH Term	Description	Entries
D007182	Income	Revenues or receipts accruing from business enterprise, labor, or invested capital.	Income Distribution,Income Generation Programs,Savings,Distribution, Income,Distributions, Income,Income Distributions,Income Generation Program,Incomes,Program, Income Generation,Programs, Income Generation
D010351	Patient Discharge	The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.	Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D011445	Prospective Payment System	A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.	Discretionary Adjustment Factor,Prospective Pricing,Prospective Reimbursement,Reimbursement, Prospective,Adjustment, Discretionary,Adjustment Factor, Discretionary,Adjustment Factors, Discretionary,Adjustments, Discretionary,Discretionary Adjustment,Discretionary Adjustment Factors,Discretionary Adjustments,Factor, Discretionary Adjustment,Factors, Discretionary Adjustment,Payment System, Prospective,Payment Systems, Prospective,Pricing, Prospective,Prospective Payment Systems,Prospective Reimbursements,Reimbursements, Prospective,System, Prospective Payment,Systems, Prospective Payment
D011787	Quality of Health Care	The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.	Pharmacy Audit,Quality of Care,Quality of Healthcare,Audit, Pharmacy,Care Quality,Health Care Quality,Healthcare Quality,Pharmacy Audits
D003625	Data Collection	Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.	Data Collection Methods,Dual Data Collection,Collection Method, Data,Collection Methods, Data,Collection, Data,Collection, Dual Data,Data Collection Method,Method, Data Collection,Methods, Data Collection
D003953	Diagnosis-Related Groups	A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.	Case Mix,DRG,Diagnosis Related Group,Diagnosis-Related Group,Case Mixes,DRGs,Diagnostic-Related Group,Group, Diagnostic-Related,Groups, Diagnostic-Related,Diagnosis Related Groups,Diagnostic Related Group,Diagnostic-Related Groups,Group, Diagnosis Related,Group, Diagnosis-Related,Group, Diagnostic Related,Groups, Diagnosis Related,Groups, Diagnosis-Related,Groups, Diagnostic Related,Related Group, Diagnosis,Related Groups, Diagnosis
D004469	Economics, Hospital	Economic aspects related to the management and operation of a hospital.	Hospital Economics,Economic, Hospital,Hospital Economic
D005069	Evaluation Studies as Topic	Works about studies that determine the effectiveness or value of processes, personnel, and equipment, or the material on conducting such studies.	Critique,Evaluation Indexes,Evaluation Methodology,Evaluation Report,Evaluation Research,Methodology, Evaluation,Pre-Post Tests,Qualitative Evaluation,Quantitative Evaluation,Theoretical Effectiveness,Use-Effectiveness,Critiques,Effectiveness, Theoretical,Evaluation Methodologies,Evaluation Reports,Evaluation, Qualitative,Evaluation, Quantitative,Evaluations, Qualitative,Evaluations, Quantitative,Indexes, Evaluation,Methodologies, Evaluation,Pre Post Tests,Pre-Post Test,Qualitative Evaluations,Quantitative Evaluations,Report, Evaluation,Reports, Evaluation,Research, Evaluation,Test, Pre-Post,Tests, Pre-Post,Use Effectiveness
D006302	Health Services Research	The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)	Health Care Research,Medical Care Research,Research, Health Services,Action Research,Health Services Evaluation,Healthcare Research,Research, Medical Care,Evaluation, Health Services,Evaluations, Health Services,Health Services Evaluations,Research, Action,Research, Health Care,Research, Healthcare
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man