The effect of Medicare's payment system for rehabilitation hospitals on length of stay, charges, and total payments
The effect of Medicare's payment system for rehabilitation hospitals on length of stay, charges, and total payments
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DOI：
10.1056/nejm199710023371406
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发表时间：
1997-10-02
影响因子：
158.5
通讯作者：
Stolov, WC
中科院分区：
文献类型：
--
作者：
Chan, L;Koepsell, TD;Stolov, WC
背景医疗保险支付康复医院的系统是基于医院在基准年期间每名出院患者的平均允许费用的限制。此后，付款有上限，但如果每名病人的收费在随后几年减少，医院将获得奖励付款。我们假设每名患者的费用在基准年期间会增加，然后在随后的几年中会减少。因此，医院将有更高的报销限额，并获得奖励，以减少他们的charge.Methods支付，我们分析了医疗保险索赔数据190,921出院69康复医院从1987年到1994年。结果在控制了通货膨胀、时间和季节性趋势后，出院患者的平均费用从基准年前出院患者的25,131美元增加到基准年出院患者的32,167美元（增加了28%，P
Background Medicare's system for the payment of rehabilitation hospitals is based on limits derived from a hospital's average allowable charges per patient discharged during a base year. Thereafter, payments are capped, but hospitals receive incentive payments if charges per patient are reduced in succeeding years. We hypothesized that per-patient charges would increase during the base year and then decrease in subsequent years. Hospitals would thus have higher reimbursement limits and receive incentive payments for reducing their charges.Methods We analyzed Medicare claims data for 190,921 discharges from 69 rehabilitation hospitals from 1987 through 1994. We compared total charges, length of stay, and interim payments before, during, and alter each hospital's base year.Results After we controlled for inflation and temporal and seasonal trends, mean charges per patient discharged increased from $25,131 for patients discharged before the base year to $32,167 for patients discharged in the base year (a 28 percent increase, P