Medicare prospective payment and the use of medical technologies in hospitals. 1988

F A Sloan, and M A Morrisey, and J Valvona
Department of Economics, Vanderbilt University, Nashville, TN 37235.

Medicare's Prospective Payment System (PPS) created incentives to reduce the application of technology to hospitalized Medicare beneficiaries. Using data from 501 hospitals from 1980 and 1983-85, this study assesses changes in use of intensive care units and use of nonsurgical procedures before versus after implementation of PPS. The percent of hospitalized patients, both Medicare and non-Medicare, admitted to intensive care units increased post-PPS. Also, stays within such units remained constant. However, the percent of inpatients to whom several nonsurgical procedures were administered was lower post-PPS. For some (e.g., CAT scanning), the percentage of inpatients having the procedure continued to increase after PPS but at a much slower rate. For others, the percent of inpatients with the procedure declined at a faster rate (e.g., intravenous pyelogram). Still others showed utilization increases during 1980-83 followed by declines thereafter (e.g., occupational and physical therapy). Before 1983, there was almost no change in the number of routine tests per inpatient (e.g., serology and blood chemistry). Afterwards, there were major decreases. PPS has influenced the inhospital use of many nonsurgical procedures by both Medicare and non-Medicare patients.

UI MeSH Term Description Entries
D007902 Length of Stay The period of confinement of a patient to a hospital or other health facility. Hospital Stay,Hospital Stays,Stay Length,Stay Lengths,Stay, Hospital,Stays, Hospital
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
D003422 Critical Care Health care provided to a critically ill patient during a medical emergency or crisis. Intensive Care,Intensive Care, Surgical,Surgical Intensive Care,Care, Critical,Care, Intensive,Care, Surgical Intensive
D003933 Diagnosis The determination of the nature of a disease or condition, or the distinguishing of one disease or condition from another. Assessment may be made through physical examination, laboratory tests, or the likes. Computerized programs may be used to enhance the decision-making process. Diagnose,Diagnoses and Examination,Antemortem Diagnosis,Diagnoses and Examinations,Examinations and Diagnoses,Postmortem Diagnosis,Antemortem Diagnoses,Diagnoses,Diagnoses, Antemortem,Diagnoses, Postmortem,Diagnosis, Antemortem,Diagnosis, Postmortem,Examination and Diagnoses,Postmortem Diagnoses
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
D006278 Medicare Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976) Health Insurance for Aged and Disabled, Title 18,Insurance, Health, for Aged and Disabled,Health Insurance for Aged, Disabled, Title 18,Health Insurance for Aged, Title 18
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old
D013514 Surgical Procedures, Operative Operations carried out for the correction of deformities and defects, repair of injuries, and diagnosis and cure of certain diseases. (Taber, 18th ed.). Surgical Procedures,Ghost Surgery,Operative Procedures,Operative Surgical Procedure,Operative Surgical Procedures,Procedure, Operative Surgical,Procedures, Operative Surgical,Surgery, Ghost,Surgical Procedure, Operative,Operative Procedure,Procedure, Operative,Procedure, Surgical,Procedures, Operative,Procedures, Surgical,Surgical Procedure

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