Medicaid prospective payment: Case-mix increase

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5....

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Detalles Bibliográficos
Autores principales: Baker, Samuel L., Kronenfeld, Jennie J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: CENTERS for MEDICARE & MEDICAID SERVICES 1990
Materias:
Research Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193102/
https://www.ncbi.nlm.nih.gov/pubmed/10113463
Descripción
Sumario:South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced.

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