Latta V B, Helbing C
Health Care Financ Rev. 1991 Summer;12(4):105-40.
The 1983 amendments to the Social Security Act (Public Law 98-21) provided for a prospective payment system (PPS), effective October 1, 1983, for most short-stay hospitals certified to provide inpatient services to Medicare beneficiaries. A brief description of the assignment process for diagnosis-related groups (DRGs) is presented, because assigning a DRG code to a short-stay hospital discharge record is tantamount to the Medicare prospective payment to the hospital, subject to certain statutory adjustments. Shifts in the distribution of the discharges and average length of stay among the DRGs since 1983 reflect the adaptation of hospitals to the incentives embedded in PPS and the ongoing refinements in the methods of assigning DRGs to discharges from short-stay hospitals. Interpretation of the shifts is based on a consideration of the significant refinements in the medical coding system, the technological and scientific advances in the practice of medicine, the effect of shifting patient treatment to alternative sites, policy or legislative changes affecting Medicare coverage, and the annual recalibration of the DRG weights.
1983年对《社会保障法》（公法98 - 21）的修正案规定了一种预期支付系统（PPS），该系统自1983年10月1日起生效，适用于大多数经认证可为医疗保险受益人提供住院服务的短期住院医院。本文简要介绍了诊断相关分组（DRGs）的分组过程，因为为短期住院医院出院记录分配DRG编码等同于医疗保险向医院进行预期支付，但需进行某些法定调整。自1983年以来，各DRGs中出院病例分布和平均住院时间的变化反映了医院对PPS中所蕴含激励措施的适应，以及在为短期住院医院出院病例分配DRGs方法上的持续改进。对这些变化的解读基于对医疗编码系统的重大改进、医学实践中的技术和科学进步、将患者治疗转移到其他场所的影响、影响医疗保险覆盖范围的政策或立法变化以及DRG权重的年度重新校准的考虑。
