Economic Outcome Under Medicare Prospective Payment at a Tertiary-Care Institution: The Effects of Demographic, Clinical, and Logistic Factors on Duration of Hospital Stay and Part A Charges for Medical Back Problems (DRG 243)

Challenges and Adverse Outcomes of Implementing Reimbursement Mechanisms Based on the Diagnosis-Related Group Classification System: A systematic review

“…Of these, the majority (n = 28; 77.8%) were published in 1990 or before. [15][16][17][18][19][20][21]23,24,[27][28][29]31,34,35,[37][38][39][40][41][42][43][44][45][46]48,49 Most studies (n = 31; 86.1%) were set in the USA. [15][16][17][18][19][20][21][22][23][24][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]…”

“…A total of 29 studies (80.6%) were quantitative in nature. [14][15][16][17]19,[21][22][23][24][26][27][28]31,32,[34][35][36][37][38][39][40][42][43][44][45][46][47][48][49] In addition, there were three qualitative (8.3%) and four mixed-method (11.1%) studies. 18,20,25,29,30,33,41 In terms of quality assessment, qualitative, quantitative and mixedmethod studies received scores of >70%, >80% and >85%, respectively; however, quantitative studies were generally higher in quality compared to qualitative and mixed-method studies [ Table 1].…”

“…upgrading or upcoding patients). [25][26][27][28]31,32,37,42,47 Personnel-related challenges were also reported by eight studies (22%); of these, one of the most important was a lack of familiarity among physicians with the DRG classification system and misconceptions regarding the objectives of the mechanism. 25,29,30,33,34,41,42,48,49 No leadership challenges were reported by any of the studies.…”

“…Studies assessing adverse outcomes resulting from the implementation of DRG-based reimbursement mechanisms are described in Table 3. [14][15][16][17][18][19][20][21][22][23][24][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Overall, 11 studies (30.6%) examined the rate of early discharge, all of which noted an increase following implementation of the mechanism. 15,[17][18][19][20]22,23,33,41,47,48 The motivation for this was due to awareness on the part of both physicians and hospital administrators of patients' costs and the desire to reduce the length of hospital stay and increase efficiency.…”

El ajuste por riesgo en la evaluación del desempeño hospitalario

“…La forma de incluirla varía, algunos autores han utilizado una medida métrica de distancia, mientras que otros han incluido variables ordinales que dan cuenta del grado de lejanía que separa la vivienda del paciente del hospital. [32][33][34] La justificación de incluir esta variable como factor de riesgo descansa en que el médico de asistencia suele mostrar cierta resistencia a dar el alta tempranamente a pacientes que tiene más dificultades para regresar, en caso necesario. No se tiene una referencia reciente de inclusión de esta variable en ajustes de riesgo pero, la justificación para incluirla continúa siendo válida.…”