Grimaldi Paul L
State Healthcare Division of Affiliated Computer Services, Inc., Rockville, MD, USA.
J Health Care Finance. 2002 Spring;28(3):32-48.
On January 1, 2002, Medicare began to replace its cost-related inpatient reimbursement method for rehabilitation hospitals and rehabilitation units in hospitals with a prospective payment system. Under the new system, Medicare pays a predetermined, fixed amount per discharge, depending on the patient's impairment level, functional status, comorbid conditions, and age. Reduced or additional amounts are paid for early transfers, short-stay outliers, patients who expire before transfer, and cost outliers. The overall objective of the new case-based system is to provide incentives for rehabilitation facilities to furnish intensive inpatient services efficiently without tarnishing the quality of care or constraining access to care. Federal actuaries estimate that the new system will cost Medicare an additional $70 million between January 1, 2002, and September 30, 2003. The actual increase may be larger.
2002年1月1日，医疗保险开始用一种前瞻性支付系统取代其针对康复医院及医院内康复科室的与成本相关的住院报销方法。在新系统下，医疗保险根据患者的损伤程度、功能状态、合并症情况及年龄，为每次出院支付预先确定的固定金额。对于提前转院、短期住院的异常值病例、转院前死亡的患者以及成本异常值病例，会支付减少或额外的金额。新的基于病例的系统的总体目标是激励康复机构高效地提供强化住院服务，同时不损害护理质量或限制获得护理的机会。联邦精算师估计，在2002年1月1日至2003年9月30日期间，新系统将使医疗保险额外支出7000万美元。实际增加额可能更大。
