Ambulatory Patient Groups, Version 3.0-A Classification System for Payment of Ambulatory Visits
Ambulatory Patient Groups, Version 3.0-A Classification System for Payment of Ambulatory Visits
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DOI：
10.1097/01.jac.0000304091.21087.08
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发表时间：
2008-01-01
影响因子：
2.3
通讯作者：
Grant, Thelma
中科院分区：
文献类型：
--
作者：
Goldfield, Norbert;Averill, Richard;Grant, Thelma
门诊病人分组（APG）是一种病人分类系统，旨在作为门诊病人前瞻性支付系统（OPPS）的基础。尽管6个主要的非医疗保险支付方在1995年至2000年期间实施了基于APG的OPPS，但基于门诊支付分类（APC）的医疗保险OPPS的实施将支付方门诊支付改革的重点转移到了基于APC的系统。不幸的是，APC OPPS实际上并不是一个预期的支付系统，基本上已经成为一个收费服务系统的变体。因此，大多数主要的非医疗保险支付者拒绝将APC作为门诊支付改革的模式，并对原始APG OPPS设计重新产生了兴趣。本文回顾了OPPS的基本组成部分，比较和对比了基于APG和APC的OPPS，描述了APG 2.0版和APG 3.0版之间的差异，并总结了付款人在实施OPPS时需要做出的关键政策决定。
The Ambulatory Patient Groups (APGs) are a patient classification system that was designed to be used as the basis of an Outpatient Prospective Payment System (OPPS).Although 6 major non-Medicare payers had implemented an APG-based OPPS between 1995 and 2000, the implementation of the Ambulatory Payment Classification (APC)-basedMedicare OPPS shifted the focus of outpatient payment reform among payers to APC-based systems. Unfortunately, the APC OPPS is not really a prospective payment system and has become essentially a variant of a fee-for-service system. As a result, most major non-Medicare payers have rejected APCs as a model for outpatient payment reform and a renewed interest in the original APG OPPS design has occurred. This article reviews the basic components of an OPPS, compares and contrasts an APG-and APC-based OPPS, describes the differences between APG, Version 2.0, and APG, Version 3.0, and summarizes the key policy decisions payers will need to make in implementing an OPPS.