Comparing outcomes of care before and after implementation of the DRG-based prospective payment system

Article Abstract:

The effects of the prospective payment system (PPS) for Medicare patients are evaluated in a series of articles in the October 17, 1990 issue of JAMA, The Journal of the American Medical Association. Under this system, hospitals are paid a fixed rate for each patient, based on the patient's diagnostic category. To evaluate whether outcomes for patients have changed since the PPS, several outcome measures for a sample of 14,012 Medicare patients were compared for the pre- (1981-1982) and post- (1985-1986) PPS era. These included in-hospital mortality, mortality 30 and 180 days after admission, discharge to nursing homes, prolonged stays in nursing homes, and readmission to hospitals. Patients were admitted with one of five diseases: congestive heart failure, heart attack, pneumonia, cerebrovascular accident (stroke), or hip fracture. Results showed a decrease in the length of stay in the hospital for all diseases, ranging from a 14 percent decrease for pneumonia to 32 percent for stroke (average for all diseases, 24 percent). In-hospital mortality fell from 16.1 percent to 12.8 percent; mortality at 30 days post-admission was 1.1 percent lower after PPS than before, while mortality at 180 days (almost 30 percent) did not change after PPS. These rates are high; they indicate that almost one third of Medicare patients with these five diseases die within six months after admission to a hospital. After implementation of PPS, fewer patients who came from their homes to be hospitalized were discharged home again (73 percent, versus 77 percent pre-PPS); the remainder went to nursing homes. For all five diseases, in-hospital mortality was three percent lower post- than pre-PPS. While it appears from these results that implementation of the PPS did not lead to poorer outcomes for Medicare patients, changes in reimbursement patterns since the mid-1980s imply that the impact of the system needs current evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Mortality, Statistics, Hospital patients

---

The effects of the DRG-based prospective payment system on quality of care for hospitalized Medicare patients: an introduction to the series

Article Abstract:

Since Medicare began in the 1960s, its cost has risen considerably, leading the US Congress in 1982 to place a prospective cap on operating expenses for each Medicare case treated in a hospital. According to the present prospective payment system (PPS), hospitals receive a flat rate for each admission, calculated according to rates determined for 470 diagnosis related groups (DRGs). However, while the PPS has reduced the rate of increase of Medicare costs, it has been alleged that it also encourages hospitals to send Medicare patients home prematurely and to deliver lower-cost care to them. To evaluate this, a four-year study sponsored by the Health Care Financing Administration of the US Department of Health and Human Services was undertaken. The study aims to assess the quality of in-hospital care for Medicare patients before and after the establishment of the PPS, and to compare the quality of post-PPS care with what it would most probably have been without that development. Data from 16,758 Medicare patients, hospitalized in five states, were evaluated. The pre-PPS period analyzed was 1981 to 1982; post-PPS studies ran between July 1985 and June 1986. Outcomes were adjusted to reflect the level of sickness at admission: the quality of care was evaluated for congestive heart failure, acute myocardial infarction (heart attack), pneumonia, cerebrovascular accident (stroke), hip fracture and depression. The study emphasized a multidisciplinary approach. Its results can be generalized to Medicare patients with the five nonpsychiatric diseases studied. Application of the findings to patients with different diseases, especially terminal conditions, may be more limited. Seven articles in the October 17, 1990 issue of The Journal of the American Medical Association report on various results from this study. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social policy

---

Studying the effects of the DRG-based prospective payment system on quality of care: design, sampling, and fieldwork

Article Abstract:

The effects of the prospective payment system (PPS) for Medicare patients are evaluated in a series of articles in the October 17, 1990 issue of JAMA, The Journal of the American Medical Association. Under this system, hospitals are paid a flat rate for each patient admitted, according to rates determined for 470 diagnosis related groups (DRGs). A national study began in 1985 to examine the effects of the PPS on the quality of care for hospitalized Medicare patients. The study design and sampling methods, fieldwork and data collection, and analysis of the representativeness of the data collected, are presented in this report. Two hundred ninety-seven hospitals were studied between January 1, 1981 and December 31, 1982, and again between July 1, 1985 and June 30, 1986; these times provided a pre- and post-PPS study period, respectively. The states included in the study were California, Texas, Indiana, Pennsylvania and Florida, and 30 geographical areas were selected within these states. Quality of care for patients treated for congestive heart failure, heart attack, pneumonia, cerebrovascular accident (or stroke), hip fracture, and depression was evaluated. The final sample included between 51 and 62 patients at each hospital; most of the 22,795 medical records requested for the review were supplied. The majority of hospitals selected for the study (97 percent) participated. Ultimately, information from 16,758 patients (8,404 pre-PPS, 8,354 post-PPS) was evaluated. The hospitals studied were a good match for the type of hospitals throughout the country with respect to urban versus rural character, size, teaching status, patient population, and related factors. Results of the study are presented in several articles. (Consumer Summary produced by Reliance Medical Information, Inc.)

Similar abstracts:

• Abstracts: Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system
• Abstracts: Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I
• Abstracts: Metabolism of cocaine by human placentas: implications for fetal exposure. A new placental enzyme in the metabolism of cocaine: an in vitro animal model
• Abstracts: Predicting bacteremia in hospitalized patients: a prospectively validated model. Health values of the seriously ill
• Abstracts: Chronic lymphocytic leukemia: new insights into biology and therapy. Genetic relatedness of lymphoid malignancies: transformation of chronic lymphocytic leukemia as a model

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.