Prospective Payment to Encourage System Wide Quality Improvement

被引:24
作者
McNair, Peter [1 ]
Borovnicar, Daniel [1 ]
Jackson, Terri [2 ]
Gillett, Steve [1 ]
机构
[1] Victorian Dept Human Serv, Funding Policy Unit, Melbourne, Vic, Australia
[2] Univ Queensland, Sch Med, Australian Ctr Econ Res Hlth, Brisbane, Qld 4072, Australia
基金
英国医学研究理事会;
关键词
hospital reimbursement; financing; quality improvement; hospital quality; ADVERSE EVENTS; COMPLICATIONS; AUSTRALIA; MEDICARE; CARE; COST; PPS;
D O I
10.1097/MLR.0b013e31818b0825
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Casemix-based inpatient prospective payment systems allocate payments for acute care based on what is done within an episode of care without regard for the outcome. To date, they have provided little incentive to improve quality. The Centers for Medicare & Medicaid Services have recently excluded 8 avoidable complications from their payment system. Objective: This study models an inpatient. prospective payment system that comprehensively excludes not-present-on-admission and other complication diagnoses from the entire funding process, effectively adding a diagnosis-related group (DRG)-specific average complication payment across all discharges. Research Design: Complication-averaged cost weights were estimated using the same patient level cost dataset used for estimating the relative resource weights for Victorian public hospitals in 2006-07. All codes with a "C" prefix (secondary diagnoses that are coded as having arisen after admission) and codes that define a condition that prima facie represent a specific complication of care were excluded from the code string. The episodes were then regrouped to DRGs and new complication-averaged cost weights were developed. Results: When complication codes were excluded across 1.2 million discharges, 1.37% became ungroupable, 14.86% included at least one complication diagnosis code, and 1.56% grouped to another DRG. Modeled funding for individual metropolitan hospitals in Victoria, Australia, was redistributed by -2.5% to 1.8%. Conclusions: The cost weights reflect the average cost of preventable and unpreventable complications and have the potential to drive improvements in clinical care. This study is in contrast to previous studies estimating the funding impact of preventing all complications.
引用
收藏
页码:272 / 278
页数:7
相关论文
共 19 条
[1]  
[Anonymous], 1985, HOSP POWER EQUILIBRI
[2]  
Averill RF, 2006, HEALTH CARE FINANC R, V27, P83
[3]  
*COMM AUSTR, 2006, AUSTR REF DIAGN REL, V1
[4]   HOSPITAL PAYMENT ARRANGEMENTS TO ENCOURAGE EFFICIENCY - THE CASE OF VICTORIA, AUSTRALIA [J].
DUCKETT, SJ .
HEALTH POLICY, 1995, 34 (02) :113-134
[5]   The incidence and cost of adverse events in Victorian hospitals 2003-2004 [J].
Ehsani, Jonathon P. ;
Jackson, Terri ;
Duckett, Stephen J. .
MEDICAL JOURNAL OF AUSTRALIA, 2006, 184 (11) :551-555
[6]   Estimating hospital deaths due to medical errors - Preventability is in the eye of the reviewer [J].
Hayward, RA ;
Hofer, TP .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 286 (04) :415-420
[8]  
Jackson Terri, 2006, J Health Serv Res Policy, V11, P21, DOI 10.1258/135581906775094271
[9]   Identifying adverse events caused by medical care: Degree of physician agreement in a retrospective chart review [J].
Localio, AR ;
Weaver, SL ;
Landis, JR ;
Lawthers, AG ;
Brennan, TA ;
Hebert, L ;
Sharp, TJ .
ANNALS OF INTERNAL MEDICINE, 1996, 125 (06) :457-464
[10]  
McNair Peter, 2002, Aust Health Rev, V25, P72