Improving Inpatient Psychiatric Payment: Cost and Quality Implications

描述（由申请人提供）：自1983年实施以来，用于住院治疗的医疗保险前瞻性支付系统（PPS）一直使用诊断相关组（DRG）来支付“每例”费用，但精神疾病除外。每例支付已证明其激励措施的效率，在医疗保险的支付住院医疗保健，但大多数住院精神病治疗是按日支付，包括新的CMS精神病前瞻性支付系统。对于精神病入院，DRGs解释了每个病例不到2%的成本。最近的研究指出了几个影响因素，其中包括未能在计费数据中捕获资源预测特性，例如，入院/严重程度状态和提供的治疗。拟议的研究旨在改善精神病DRGs（由CMS实施）和APR-DRGs（由3 M健康信息系统开发，并由马里兰州的每例支付系统使用）。通过更好地使用账单数据，加上可以从医疗记录中捕获的补充数据，这一目标似乎是可以实现的。此外，该研究还将试点收集住院精神科表现（质量）指标，包括患者安全和出院后指标。该试点将提供洞察下，每例支付马里兰州系统的质量性能，并有可能模拟成本和支付住院精神病学的性能支付的潜在影响。将评估为病例组合分类和业绩计量收集更多数据要素的费用。该研究将测试假设，并使用模拟建模来检查改进的DRGs和APR-DRGs的解释力，改进的casemix措施对收入相对于医院水平成本的分布的影响，以及绩效与医院和患者特征的关系。这项研究将与马里兰州卫生服务成本审查委员会（HSCRC）和马里兰州精神卫生管理局（MHA）合作进行。根据州法律，HSCRC有权在医疗保险/医疗补助豁免的情况下为马里兰州的所有付款人制定医院费率。本研究结果可望应用于马里兰州的HSCRC。此外，该项目还设有一个具有广泛代表性的政策咨询委员会，以确保与国家相关。

DESCRIPTION (provided by applicant): Medicare Prospective Payment System (PPS) for inpatient hospital care has used Diagnostic Related Groups (DRG) to pay "per case" since its implementation in 1983, except for psychiatric disorders. Per case payment has demonstrated its incentives for efficiency in Medicare's payment for inpatient medical care yet most of inpatient psychiatric care is paid per diem, including the new CMS psychiatric prospective payment system. For psychiatric admissions, DRGs explain a little less than 2% of costs per case. Recent research points to several contributing factors, among them failure to capture in billing data resource predictive characteristics, e.g., admission/severity status and treatments provided. The proposed research seeks to improve psychiatric DRGs (as implemented by CMS) and APR-DRGs (as developed by 3M Health Information Systems and used by Maryland's all payer per case payment system). This goal appears achievable with better use of billing data, plus supplemental data that could be captured from medical records. Also, the study will pilot the collection of inpatient psychiatric performance (quality) measures, including patient safety and post-discharge measures. The pilot will provide insight into the quality performance of the Maryland system under per case payment and make it possible to simulate potential effects on costs and payments of pay for performance for inpatient psychiatry. The cost of collecting additional data elements for casemix classification and for performance measurement will be assessed. The research will test hypotheses and use simulation modeling to examine the explanatory power of improved DRGs and APR-DRGs, effects of improved casemix measures on the distribution of revenues relative to costs at the hospital-level, and the relationship of performance to hospital and patient characteristics. The research will be undertaken in collaboration with the State of Maryland Health Services Cost Review Commission (HSCRC) and Maryland Mental Hygiene Administration (MHA). The HSCRC has authority under State law, operating with Medicare/Medicaid waivers, to set hospital rates for all payers in Maryland. The findings of this research are expected to be applied in Maryland by the HSCRC. In addition, the project has a Policy Advisory Committee with broad representation that will ensure national relevance.