ABSTRACT
This article describes efforts by HCFA to implement global payment demonstrations for Medicare fee for service inpatients. The Medicare Heart Bypass Center Demonstration operated from 1991 to 1996, and used global payments to pay for bypass surgery inpatient episodes. The demonstration operated effectively, with significant cost reductions at many sites and improvements in quality of care. The Medicare Program and its beneficiaries saved over $52 million in that demonstration. The planned Medicare Participating Centers of Excellence Demonstration and the Medicare Provider Partnerships Demonstration will also use global payment methods. These demonstrations will include cardiac and orthopedic care in the Centers demonstration, and all types of medical and surgical cases in Provider Partnerships. Successful implementation of these demonstrations could lead to expansion of global payment methods in the Medicare Program, with increases in efficiency and cost savings anticipated.
Subject(s)
Coronary Artery Bypass/economics , Episode of Care , Medicare/organization & administration , Organizational Innovation , Organizational Policy , Reimbursement, Incentive , Aged , Benchmarking , Centers for Medicare and Medicaid Services, U.S. , Cost Savings , Humans , Pilot Projects , Social Change , Treatment Outcome , United StatesABSTRACT
The Ambulatory Patient Group (APGs) are a patient classification system that was developed to be used as the basis of a prospective payment system (PPS) for the facility costs of outpatient care. This article will review the key characteristics of a patient classification system for ambulatory care, describe the APG development process, and describe a payment model based on the APGs. We present the results of simulating the use of APGs in a prospective payment system, and conclude with a discussion of the implementation issues associated with an outpatient PPS.
